BMC Infect Dis . Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study

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BMC Infect Dis


. 2021 Nov 1;21(1):1127.
doi: 10.1186/s12879-021-06813-1.
Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study


Ohoud Aljuhani ¹ , Khalid Al Sulaiman ^{2 3 4} , Adel Alshabasy ^{5 6} , Khalid Eljaaly ^{7 8} , Abdulrahman I Al Shaya ^{2 3 4} , Haytham Noureldeen ^{5 6} , Mohammed Aboudeif ⁵ , Bodoor Al Dosari ⁹ , Amina Alkhalaf ⁷ , Ghazwa B Korayem ¹⁰ , Muneera M Aleissa ^{10 11} , Hisham A Badreldin ^{2 3 4} , Shmeylan Al Harbi ^{2 3 4} , Abdullah Alhammad ¹² , Ramesh Vishwakarma ⁴



Affiliations

• PMID: 34724920
• DOI: 10.1186/s12879-021-06813-1

Abstract

Background: Tocilizumab is an IgG1 class recombinant humanized monoclonal antibody that directly inhibits the IL-6 receptor. Several randomized clinical trials have evaluated its safety and efficacy in patients with coronavirus disease 2019 (COVID-19), and these studies demonstrate conflicting results. Our study aimed to determine the association between tocilizumab treatment and microbial isolation and emergence of multidrug-resistant bacteria in critically ill patients with COVID-19.
Methods: A multicenter retrospective cohort study was conducted at two tertiary government hospitals in Saudi Arabia. All critically ill patients admitted to intensive care units with a positive COVID-19 PCR test between March 1 and December 31, 2020, who met study criteria were included. Patients who received tocilizumab were compared to those who did not receive it.
Results: A total of 738 patients who met our inclusion criteria were included in the analysis. Of these, 262 (35.5%) received tocilizumab, and 476 (64.5%) were included in the control group. Patients who received tocilizumab had higher odds for microbial isolation (OR 1.34; 95% CI 0.91-1.94, p = 0.13); however, the difference was not statistically significant. Development of resistant organisms (OR 1.00; 95% CI 0.51-1.98, p = 0.99) or detection of carbapenem-resistant Enterobacteriaceae (CRE) (OR 0.67; 95% CI 0.29-1.54, p = 0.34) was not statistically significant between the two groups.
Conclusions: Tocilizumab use in critically ill patients with COVID-19 is not associated with higher microbial isolation, the emergence of resistant organisms, or the detection of CRE organisms.

Keywords: COVID-19; CRE; Critically ill; Immunomodulatory drugs; Intensive care units (ICUs); SARS-Cov-2; Secondary infection; Tocilizumab.