tetano
Editor, Senior Moderator
MC Infect Dis
. 2026 Aug 1;26(1):1905.
doi: 10.1186/s12879-026-14144-2.
Ling Xu 1 , Yongzhe Liu 1 , Ran Li 1 , Chen Ma 1 , Jun Liu 1 , Boyuan Yang 1 , Kewu Huang 2 , Hangyong He 3 4 , Li Gu 5
Affiliations Expand
Background: Baricitinib was shown to reduce the mortality of COVID-19 patients, but real world data about baricitinib in combination with nirmatrelvir/ritonavir for the treatment of elderly patients with severe or critical COVID-19 were limited. The aim of the study was to determine the effects and hospital-acquired infections occurrence after combined medication in these patients.
Methods: We included severe or critical COVID-19 patients treated at Beijing Chaoyang Hospital from December 2022 to February 2023. We investigated duration of hospital stay, factors associated with reduced mortality risk, IL-6 levels and the characteristics of hospital-acquired infections in patients treated with baricitinib with nirmatrelvir/ritonavir.
Results: The median age of the 117 included patients was 79 (interquartile range [IQR]: 70-85) years. Thirty-six patients received baricitinib with nirmatrelvir/ritonavir, 16 of whom died. The factors associated with reduced mortality were the administration of baricitinib with nirmatrelvir/ritonavir (hazard ratio
: 0.405 (95% CI: 0.183-0.90), p = 0.026)). The IL-6 levels were 0.75 (IQR: 0.55-1.82) log10 pg/mL before or within 2 days of baricitinib administration, and it was 1.45 (IQR: 0.94-2.07) log10 pg/mL after baricitinib administration for 6 to 8 days. A mixed-effects model showed a statistically significant effect of Time on IL-6 levels (F(1, 20.757) = 6.299, p = 0.020). The fixed effects estimates indicated that each one-day increase during the treatment period, IL-6 levels increased by an average of 0.081 units (B = 0.081, SE = 0.032, t (20.757) = 2.510, p = 0.020, 95% CI (0.014, 0.148)). In patients treated with baricitinib, carbapenem-resistant Acinetobacter baumannii (2), carbapenem-resistant Klebsiella pneumoniae (2), and K. pneumoniae (2) were more common pathogens detected in the respiratory tract. Carbapenem-resistant K. pneumoniae (1), Enterococcus faecium (1), and Staphylococcus epidermidis (1) were detected in blood. Enterococcus faecium (2) and K. pneumoniae (1) were identified via urine culture.
Conclusion: Baricitinib combined with nirmatrelvir/ritonavir was associated with lower mortality in elderly patients with severe or critical COVID-19 in the real world. Carbapenem-resistant A.baumanniiand carbapenem-resistant K. pneumoniae were more common pathogens detected in the respiratory tract in these patients.
Clinical trial number: Not applicable.
Keywords: Baricitinib; COVID-19; Carbapenem-resistant Klebsiella pneumonia; Critical; Elderly.
. 2026 Aug 1;26(1):1905.
doi: 10.1186/s12879-026-14144-2.
Effects and infection risks of baricitinib in combination with nirmatrelvir/ritonavir in elderly patients with severe or critical COVID-19: a retrospective observational cohort study
Ling Xu 1 , Yongzhe Liu 1 , Ran Li 1 , Chen Ma 1 , Jun Liu 1 , Boyuan Yang 1 , Kewu Huang 2 , Hangyong He 3 4 , Li Gu 5
Affiliations Expand
- PMID: 42958072
- PMCID: PMC13721712
- DOI: 10.1186/s12879-026-14144-2
Abstract
Background: Baricitinib was shown to reduce the mortality of COVID-19 patients, but real world data about baricitinib in combination with nirmatrelvir/ritonavir for the treatment of elderly patients with severe or critical COVID-19 were limited. The aim of the study was to determine the effects and hospital-acquired infections occurrence after combined medication in these patients.
Methods: We included severe or critical COVID-19 patients treated at Beijing Chaoyang Hospital from December 2022 to February 2023. We investigated duration of hospital stay, factors associated with reduced mortality risk, IL-6 levels and the characteristics of hospital-acquired infections in patients treated with baricitinib with nirmatrelvir/ritonavir.
Results: The median age of the 117 included patients was 79 (interquartile range [IQR]: 70-85) years. Thirty-six patients received baricitinib with nirmatrelvir/ritonavir, 16 of whom died. The factors associated with reduced mortality were the administration of baricitinib with nirmatrelvir/ritonavir (hazard ratio
: 0.405 (95% CI: 0.183-0.90), p = 0.026)). The IL-6 levels were 0.75 (IQR: 0.55-1.82) log10 pg/mL before or within 2 days of baricitinib administration, and it was 1.45 (IQR: 0.94-2.07) log10 pg/mL after baricitinib administration for 6 to 8 days. A mixed-effects model showed a statistically significant effect of Time on IL-6 levels (F(1, 20.757) = 6.299, p = 0.020). The fixed effects estimates indicated that each one-day increase during the treatment period, IL-6 levels increased by an average of 0.081 units (B = 0.081, SE = 0.032, t (20.757) = 2.510, p = 0.020, 95% CI (0.014, 0.148)). In patients treated with baricitinib, carbapenem-resistant Acinetobacter baumannii (2), carbapenem-resistant Klebsiella pneumoniae (2), and K. pneumoniae (2) were more common pathogens detected in the respiratory tract. Carbapenem-resistant K. pneumoniae (1), Enterococcus faecium (1), and Staphylococcus epidermidis (1) were detected in blood. Enterococcus faecium (2) and K. pneumoniae (1) were identified via urine culture.
Conclusion: Baricitinib combined with nirmatrelvir/ritonavir was associated with lower mortality in elderly patients with severe or critical COVID-19 in the real world. Carbapenem-resistant A.baumanniiand carbapenem-resistant K. pneumoniae were more common pathogens detected in the respiratory tract in these patients.
Clinical trial number: Not applicable.
Keywords: Baricitinib; COVID-19; Carbapenem-resistant Klebsiella pneumonia; Critical; Elderly.