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

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.

Ketamine-based Sedation Use in Mechanically Ventilated Critically Ill Patients with COVID-19: A Multicenter Cohort Study

“…This study was carried out under the auspices of the Saudi Critical Care Pharmacy Research (SCAPE) platform, which also conducted other investigations to evaluate the safety and effectiveness of various therapies in critically ill patients ( SCAPE, n.d. ). The methodology of this multicenter cohort study is comparable to other studies executed by the SCAPE platform and previously reported ( Al Harbi et al, 2022 , Al Sulaiman et al, 2022b , Al Sulaiman et al, 2022a , Al Sulaiman et al, 2021a , Al Sulaiman et al, 2021b , Aljuhani et al, 2021 ). The supplemental material contains additional details on the study's design.…”

The Clinical Manifestation of SARS-CoV-2 in Critically Ill Patients with Klebsiella pneumoniae NDM Hospitalized in the ICU of a Modular Hospital during the Third Wave of the Pandemic in Poland—An Observational Cohort Study

“…We administered tocilizumab in one case only. Data from Aljuhani et al [24] revealed the lack of association between such treatment and the incidence of MDR.…”

Evaluation of Early Tocilizumab Effect on Multiorgan Dysfunction in Critically Ill Patients With COVID-19: A Propensity Score-Matched Study

“…Our results showed no difference in the length of stay; similarly, a systematic review and metaanalysis by Rezaei et al showed no statistically significant difference in hospital length of stay. 17 We believe our study is one of the first studies that suggest a potential role of TCZ in preventing multiorgan dysfunction in critically ill patients with COVID-19 if further confirmed in large RCTs. The aforementioned trials studied organ dysfunction in terms of respiratory and cardiovascular organ support free day in the REMAB-CAP and receiving mechanical ventilation or hemofiltration in the RECOVERY trial while our study measured the MOD score which accounts for the severity of MOD in six organ systems including respiratory, cardiovascular, renal, hematological, hepatic failure, and central nervous system.…”

“…Our results showed no difference in the length of stay; similarly, a systematic review and meta-analysis by Rezaei et al showed no statistically significant difference in hospital length of stay. 17 …”