Dexamethasone therapy and rates of secondary pulmonary and bloodstream infections in critically ill COVID-19 patients

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 multidrug-resistant 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.

No increase of device associated infections in German intensive care units during the start of the COVID-19 pandemic in 2020

“…The care of COVID-19 patients is associated with a more frequent use of personal protective equipment and a disruption of routine infection control practices. In addition, many hospitalized COVID-19 patients receive corticosteroid therapy, which may increase the risk of developing super-infections [ 5 ]. The risk for severe COVID-19 infection increased for patients with comorbidities.…”

Epidemiology and outcomes of culture-positive bloodstream pathogens prior to and during the SARS-CoV-2 pandemic: a multicenter evaluation

“…However, most studies on the epidemiology of BSI during the COVID-19 pandemic have been of short duration and report on the early period of the pandemic [7][8][9], highlighting a need for data that capture the impact of clinically relevant COVID-19 variants, including the Delta variant, and reflect the use of immunomodulatory agents, which could affect the risk of secondary infections [10].…”

Targeting C5aR1 signaling reduced neutrophil extracellular traps and ameliorates COVID-19 pathology

“…Nevertheless, clinical results from a small cohort indicated that inhibition of C5a reduced COVID-19 hyper-inflammation and improved lung function (Mastellos et al, 2020). Noteworthy, the hypothesis that the blockage of C5aR1 signaling would be beneficial to COVID-19 may open another important question related to secondary infections that are extremely common in COVID-19 patients and are a critical threat in the current treatments targeting the immune response (Lee et al, 2003; Hoenigl et al, 2022; Grasselli et al, 2021; Kooistra et al, 2021; Rothe et al, 2021). Although, inhibition of C5 by neutralizing antibodies has been associated with increased risk of bacterial infection due to the inhibition of the formation of the membrane attack complex, the selective targeting of C5a/C5aR1 signaling may avoid harmful anaphylatoxins-induced effects (Crew et al, 2019; Langereis et al, 2020).…”