Chemaly et al reported criteria for identifying a refractory cytomegalovirus infection in transplant recipients. The authors are from multiple institutions in the United States and Europe.
Term
Type
Criteria
refractory
clinical
suboptimal response to therapy
resistant
laboratory
(1) drug resistant growth or (2) mutations associated with resistance
Patient selection: >= 2 weeks of appropriately dosed antiviral therapy
Parameters at follow-up compared to baseline:
(1) CMV viremia (viral load) during appropriately dosed antiviral therapy
(2) signs and symptoms of end-organ damage
CMV Viremia
Designation
increasing (delta LOG10 >= 1)
refractory
persistent (delta LOG 10 >=0 AND < 1)
probable refractory
delta LOG 10 =
= LOG10(viral load at follow-up) - LOG10(at baseline)
Signs and Symptoms
Designation
worsening or progression
refractory end-organ damage
persistent with lack of improvement
probable end-organ damage
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