Increased Secondary Infection in COVID-19 Patients Treated with Steroids in New York City

Obata, Reiichiro; Maeda, Tetsuro; Rizk, Dahlia; Kuno, Toshiki

doi:10.7883/yoken.jjid.2020.884

Cited by 55 publications

(48 citation statements)

References 25 publications

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“…Our pooled estimates were also based on the results mainly from the first wave of the pandemic before the RECOVERY trial 13 was published. With universal administration of systemic steroids to patients with severe COVID‐19, overall mortality will likely decrease, but an increase in the incidence of CAPA is possible 43,44 . The incidence and mortality under the current treatment strategy will likely change based on the new case definitions for CAPA 5 .…”

Section: Discussionmentioning

confidence: 99%

Incidence and mortality of COVID‐19‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Mitaka

Kuno

Takagi

et al. 2021

Mycoses

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COVID‐19‐associated pulmonary aspergillosis (CAPA) has been reported worldwide. However, basic epidemiological characteristics have not been well established. In this systematic review and meta‐analysis, we aimed to determine the incidence and mortality of CAPA in critically ill patients with COVID‐19 to improve guidance on surveillance and prognostication. Observational studies reporting COVID‐19‐associated pulmonary aspergillosis were searched with PubMed and Embase databases, followed by an additional manual search in April 2021. We performed a one‐group meta‐analysis on the incidence and mortality of CAPA using a random‐effect model. We identified 28 observational studies with a total of 3148 patients to be included in the meta‐analysis. Among the 28 studies, 23 were conducted in Europe, two in Mexico and one each in China, Pakistan and the United States. Routine screening for secondary fungal infection was employed in 13 studies. The modified AspICU algorithm was utilised in 15 studies and was the most commonly used case definition and diagnostic algorithm for pulmonary aspergillosis. The incidence and mortality of CAPA in the ICU were estimated to be 10.2% (95% CI, 8.0–12.5; I2 = 82.0%) and 54.9% (95% CI, 45.6–64.2; I2 = 62.7%), respectively. In conclusion, our estimates may be utilised as a basis for surveillance of CAPA and prognostication in the ICU. Large, prospective cohort studies based on the new case definitions of CAPA are warranted to validate our estimates.

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Section: Discussionmentioning

confidence: 99%

Incidence and mortality of COVID‐19‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Mitaka

Kuno

Takagi

et al. 2021

Mycoses

Self Cite

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“…In addition, bacterial and opportunistic infections during or after steroid treatment are a major concern and recognized side effect, even at low doses and short courses [ 6 , 29 , 30 ], being a possible limitation for its use in COVID-19 patients. As a matter of fact, Obata et al found that steroids but not tocilizumab were associated with higher rates of bacterial and fungal infection in COVID-19 hospitalized patients [ 31 ]. However, in our cohort neither steroid treatment nor tocilizumab exposure carried a significant risk of bacterial infection when adjusted in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Bacterial infections in patients hospitalized with COVID-19

et al. 2021

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Bacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (p < 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (p < 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively; p < 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (p < 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population.

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“…It may also highlight the role of secondary infection in the deterioration of patients' health status. Interestingly, the use of steroids was reported to be associated with secondary infection (43,44).…”

Section: Discussionmentioning

confidence: 99%

Clinical and Laboratory Findings of COVID-19 in High-Altitude Inhabitants of Saudi Arabia

et al. 2021

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Background: SARS-CoV-2, the causative agent of COVID-19, continues to cause a worldwide pandemic, with more than 147 million being affected globally as of this writing. People's responses to COVID-19 range from asymptomatic to severe, and the disease is sometimes fatal. Its severity is affected by different factors and comorbidities of the infected patients. Living at a high altitude could be another factor that affects the severity of the disease in infected patients.Methods: In the present study, we have analyzed the clinical, laboratory, and radiological findings of COVID-19-infected patients in Taif, a high-altitude region of Saudi Arabia. In addition, we compared matched diseased subjects to those living at sea level. We hypothesized that people living in high-altitude locations are prone to develop a more severe form of COVID-19 than those living at sea level.Results: Age and a high Charlson comorbidity score were associated with increased numbers of intensive care unit (ICU) admissions and mortality among COVID-19 patients. These ICU admissions and fatalities were found mainly in patients with comorbidities. Rates of leukocytosis, neutrophilia, higher D-dimer, ferritin, and highly sensitive C-reactive protein (CRP) were significantly higher in ICU patients. CRP was the most independent of the laboratory biomarkers found to be potential predictors of death. COVID-19 patients who live at higher altitude developed a less severe form of the disease and had a lower mortality rate, in comparison to matched subjects living at sea level.Conclusion: CRP and Charlson comorbidity scores can be considered predictive of disease severity. People living at higher altitudes developed less severe forms of COVID-19 disease than those living at sea level, due to a not-yet-known mechanism.

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Increased Secondary Infection in COVID-19 Patients Treated with Steroids in New York City

Cited by 55 publications

References 25 publications

Incidence and mortality of COVID‐19‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Incidence and mortality of COVID‐19‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Bacterial infections in patients hospitalized with COVID-19

Clinical and Laboratory Findings of COVID-19 in High-Altitude Inhabitants of Saudi Arabia

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