Late onset infectious complications and safety of tocilizumab in the management of COVID‐19

Pettit, Natasha N; Nguyen, Cynthia T; Mutlu, Gökhan M.; Wu, David; Kimmig, Lucas; Pitrak, David; Pursell, Kenneth

doi:10.1002/jmv.26429

Cited by 78 publications

(67 citation statements)

References 24 publications

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“…Seven patients in the C-ARDS group received tocilizumab. Anti-inflammatory treatment may be associated with Table 3 Diagnostic the development of bloodstream infection or late onset infections in recent studies [33,34].…”

Section: Mechanical Ventilationmentioning

confidence: 99%

Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease

et al. 2020

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Background Data on incidence of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with severe SARS-CoV-2 infection are limited. Methods We conducted a monocenter retrospective study comparing the incidence of VAP and invasive aspergillosis between patients with COVID-19-related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS). Results We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 h. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p < 0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS: 58 (64%) vs. 36 (44%), p = 0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14–2.52), p < 0.01]. The incidence of multi-drug-resistant bacteria (MDR)-related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p = 0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p < 0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p = 0.003], but there was no difference in Aspergillus colonization. Conclusions In our experience, we evidenced a higher incidence of VAP and MDR-VAP in C-ARDS than in NC-ARDS and a lower risk for invasive aspergillosis in the former group.

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Section: Mechanical Ventilationmentioning

confidence: 99%

Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease

et al. 2020

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“…Although the first concern that inflammatory response modifiers could worsen the prognosis of COVID-19 by increasing viral replication or persistence has been mitigated by clinical experience, the possibility that they may still increase the rate of hospital-acquired infection has not been completely discarded [10][11][12][13][14]. The aim of the present study was to investigate the possible influence of the administration of inflammatory response modifiers, including anti-IL-6 biologics and corticosteroids, on the incidence of hospitalacquired infections in admitted patients with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Impact of Inflammatory Response Modifiers on the Incidence of Hospital-Acquired Infections in Patients with COVID-19

et al. 2021

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Introduction:The study aim was to assess the influence of inflammatory response modifiers, including anti-interleukin-6 (IL-6) biologics and corticosteroids, on the incidence of hospitalacquired infections in patients with coronavirus disease 2019 . Methods: Case-control study performed at a university hospital from February 26 to May 26, 2020. Cases were defined as patients with COVID-19 who developed hospital-acquired infections. For each case, two controls were selected among patients without infections. Cases and controls were matched obeying three criteria in a hierarchical sequence: length of hospital stay up until the first infection; comorbidity; and need for Intensive care unit (ICU) admission. Conditional logistic regression analysis was used to estimate the association of exposures with being a case. Results: A total of 71 cases and 142 controls were included. Independent predictors for acquiring a hospital infection were chronic liver disease [odds ratio (OR) 16.56, 95% CI 1.87-146.5, p = 0.012], morbid obesity (OR 6.11, 95% CI 1.06-35.4, p = 0.043), current or past smoking (OR 4.15, 95% CI 1.45-11.88, p = 0.008), exposure to hydroxychloroquine (OR 0.2, 95% CI 0.041-1, p = 0.053), and invasive mechanical ventilation (OR 61.5, 95% CI 11.08-341, p B 0.0001). Conclusions: Inflammatory response modifiers had no influence on acquisition of nosocomial infections in admitted patients with COVID-19. Hospital-acquired infections primarily occurred in the critically ill and invasive mechanical ventilation was the main exposure conferring risk.

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“…Nonetheless, dampening the inflammatory response during infectious diseases may impair the desired host response and predispose to secondary infections. In keeping with this, a recent single‐center retrospective case‐review analyzing the clinical outcomes and secondary infections' rates in COVID‐19 patients receiving the anti‐interleukin 6 inhibitor, Tocilizumab, found a significantly higher mortality rate and occurrence of secondary infections, particularly of bacterial pneumonia superinfections, in patients treated with this immunosuppressive drug (Kimmig et al, 2020; Pettit et al, 2020). Most of these ongoing trials, hence, reserve these drugs for severely ill patients, given their unwanted side effects, particularly in mild forms of infection (Nguyen et al, 2020).…”

Section: Nutraceuticals During the Covid‐19 Pandemic: State Of The Artmentioning

confidence: 83%

Phytotherapics in COVID19: Why palmitoylethanolamide?

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et al. 2020

Phytotherapy Research

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At present, googling the search terms "COVID-19" and "Functional foods" yields nearly 500,000,000 hits, witnessing the growing interest of the scientific community and the general public in the role of nutrition and nutraceuticals during the COVID-19 pandemic. Many compounds have been proposed as phytotherapics in the prevention and/or treatment of COVID-19. The extensive interest of the general public and the enormous social media coverage on this topic urges the scientific community to address the question of whether which nutraceuticals can actually be employed in preventing and treating this newly described coronavirus-related disease. Recently, the Canadian biotech pharma company "FSD Pharma" received the green light from the Food and Drug Administration to design a proof-of-concept study evaluating the effects of ultramicronized palmitoylethanolamide (PEA) in COVID-19 patients. The story of PEA as a nutraceutical to prevent and treat infectious diseases dates back to the 1970s where the molecule was branded under the name Impulsin and was used for its immunomodulatory properties in influenza virus infection. The present paper aims at analyzing the potential of PEA as a nutraceutical and the previous evidence suggesting its anti-inflammatory and immunomodulatory properties in infectious and respiratory diseases and how these could translate to COVID-19 care.

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Late onset infectious complications and safety of tocilizumab in the management of COVID‐19

Cited by 78 publications

References 24 publications

Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease

Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease

Impact of Inflammatory Response Modifiers on the Incidence of Hospital-Acquired Infections in Patients with COVID-19

Phytotherapics in COVID19: Why palmitoylethanolamide?

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