tetano
Editor, Senior Moderator
Multidiscip Respir Med
. 2021 Oct 28;16(1):793.
doi: 10.4081/mrm.2021.793. eCollection 2021 Jan 15.
Dexamethasone therapy and rates of secondary pulmonary and bloodstream infections in critically ill COVID-19 patients
Kathrin Rothe[SUP] 1 [/SUP], Tobias Lahmer[SUP] 2 [/SUP], Sebastian Rasch[SUP] 2 [/SUP], Jochen Schneider[SUP] 2 [/SUP], Christoph D Spinner[SUP] 2 3 [/SUP], Fabian Wallnöfer[SUP] 2 [/SUP], Milena Wurst[SUP] 2 [/SUP], Roland M Schmid[SUP] 2 [/SUP], Birgit Waschulzik[SUP] 4 [/SUP], Kristina Fuest[SUP] 5 [/SUP], Silja Kriescher[SUP] 5 [/SUP], Gerhard Schneider[SUP] 5 [/SUP], Dirk H Busch[SUP] 1 3 [/SUP], Susanne Feihl[SUP] 1 [/SUP], Markus Heim[SUP] 5 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) has become a pandemic. Bacterial superinfections seem to be associated with higher mortality in COVID-19 patients in intensive care units (ICUs). However, details on the prevalence and species distribution of secondary infections are limited. Moreover, the increasing use of dexamethasone may pose an additional risk of superinfections.
Methods: We performed a single-center retrospective study of the clinical and microbiological characteristics of 154 COVID-19 patients admitted to the ICU between March 2020 and January 2021, focusing on bacterial infections, use of antimicrobial agents and dexamethasone therapy.
Results: The median age was 68 years; 67.5% of the patients were men. Critically ill COVID-19 patients were treated with dexamethasone since July 2020 (second wave), which was not common during the first wave of the pandemic. In the dexamethasone group (n=90, 58.4%), respiratory pathogens were detected more frequently, as were multidrugresistant pathogens. The number of patients with polymicrobial detection of respiratory pathogens was significantly increased (p=0.013). The most frequently detected species were Enterobacterales, Staphylococcus aureus, and Aspergillus fumigatus. The rates of bloodstream infections did not differ between the groups. The use of dexamethasone in ICU COVID-19 patients was associated with higher rates of respiratory infectious complications.
Conclusions: Secondary infections are present in a substantial fraction of critically ill COVID-19 patients. Respiratory pathogens were detectable in the majority of COVID-19 ICU patients. The use of dexamethasone poses a potential risk of secondary pulmonary infections. Infectious complications in patients with dexamethasone therapy could be associated with worse outcomes.
Keywords: COVID-19; SARS-CoV-2; antibiotic stewardship; bacterial infection; critical care; dexamethasone.
. 2021 Oct 28;16(1):793.
doi: 10.4081/mrm.2021.793. eCollection 2021 Jan 15.
Dexamethasone therapy and rates of secondary pulmonary and bloodstream infections in critically ill COVID-19 patients
Kathrin Rothe[SUP] 1 [/SUP], Tobias Lahmer[SUP] 2 [/SUP], Sebastian Rasch[SUP] 2 [/SUP], Jochen Schneider[SUP] 2 [/SUP], Christoph D Spinner[SUP] 2 3 [/SUP], Fabian Wallnöfer[SUP] 2 [/SUP], Milena Wurst[SUP] 2 [/SUP], Roland M Schmid[SUP] 2 [/SUP], Birgit Waschulzik[SUP] 4 [/SUP], Kristina Fuest[SUP] 5 [/SUP], Silja Kriescher[SUP] 5 [/SUP], Gerhard Schneider[SUP] 5 [/SUP], Dirk H Busch[SUP] 1 3 [/SUP], Susanne Feihl[SUP] 1 [/SUP], Markus Heim[SUP] 5 [/SUP]
Affiliations
- PMID: 34760275
- PMCID: PMC8567088
- DOI: 10.4081/mrm.2021.793
Abstract
Background: Coronavirus disease 2019 (COVID-19) has become a pandemic. Bacterial superinfections seem to be associated with higher mortality in COVID-19 patients in intensive care units (ICUs). However, details on the prevalence and species distribution of secondary infections are limited. Moreover, the increasing use of dexamethasone may pose an additional risk of superinfections.
Methods: We performed a single-center retrospective study of the clinical and microbiological characteristics of 154 COVID-19 patients admitted to the ICU between March 2020 and January 2021, focusing on bacterial infections, use of antimicrobial agents and dexamethasone therapy.
Results: The median age was 68 years; 67.5% of the patients were men. Critically ill COVID-19 patients were treated with dexamethasone since July 2020 (second wave), which was not common during the first wave of the pandemic. In the dexamethasone group (n=90, 58.4%), respiratory pathogens were detected more frequently, as were multidrugresistant pathogens. The number of patients with polymicrobial detection of respiratory pathogens was significantly increased (p=0.013). The most frequently detected species were Enterobacterales, Staphylococcus aureus, and Aspergillus fumigatus. The rates of bloodstream infections did not differ between the groups. The use of dexamethasone in ICU COVID-19 patients was associated with higher rates of respiratory infectious complications.
Conclusions: Secondary infections are present in a substantial fraction of critically ill COVID-19 patients. Respiratory pathogens were detectable in the majority of COVID-19 ICU patients. The use of dexamethasone poses a potential risk of secondary pulmonary infections. Infectious complications in patients with dexamethasone therapy could be associated with worse outcomes.
Keywords: COVID-19; SARS-CoV-2; antibiotic stewardship; bacterial infection; critical care; dexamethasone.