Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19

Hong, Jin Yeong; Ko, Jae-Hoon; Yang, Jinyoung; Ha, Soyoung; Nham, Eliel; Huh, Kyungmin; Cho, Sun Young; Kang, Cheol-In; Chung, Doo Ryeon; Baek, Jin Yang; Sohn, You Min; Park, Hyo Jung; Lee, Beomki; Huh, Hee Jae; Kang, Eun‐Suk; Suh, Gee Young; Chung, Chi Ryang; Peck, Kyong Ran

doi:10.3349/ymj.2022.63.5.430

Cited by 7 publications

(4 citation statements)

References 22 publications

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“… 12 This was recommended based on some randomized controlled studies in which its use, combined with dexamethasone, showed some benefit in terms of survival. 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

“…12 This was recommended based on some randomized controlled studies in which its use, combined with dexamethasone, showed some benefit in terms of survival. 13,14 Our patient presented with risk factors in addition to immunosuppression due to diabetes, such as broad antibiotic use, hemofiltration procedures, and central venous and urinary catheters. 15 These factors altogether allowed the pulmonary invasion of the Trichosporon asahii.…”

Section: Discussionmentioning

confidence: 99%

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A 71-Year-Old Man From Ecuador With a History of Type 2 Diabetes Mellitus and Severe COVID-19 Pneumonia and Lung Cavitation Associated With Triple Infection With Trichosporon Asahii, Klebsiella Pneumoniae, and Pseudomonas Aeruginosa

Claudett

Briones-Claudett²,

Loor³

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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Unvaccinated patients with comorbidities that impair the immune function, such as type 2 diabetes mellitus, are more likely to develop severe COVID-19. The COVID-19-associated acute respiratory distress syndrome has raised new concerns in intensive care units globally owing to the presence of secondary fungal infections. We report the case of a 71-year-old man from Ecuador with a history of type 2 diabetes mellitus, severe COVID-19 pneumonia, and lung cavitation associated with triple infections with Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The patient with a history of high blood pressure and type 2 diabetes was admitted to our hospital from a private care center with a diagnosis of COVID-19-associated acute respiratory distress syndrome. On arrival, the patient presented with signs of hypoxemic respiratory failure. During his stay at another hospital, he had received tocilizumab and corticosteroid therapy. Therefore, intubation was performed and mechanical ventilation was initiated. The patient developed a septic shock and renal failure with a glomerular filtration rate of 27.5 mL/min/1.73 m2; therefore, two hemodiafiltration sessions were started. The bronchoalveolar lavage revealed erythematous lesions in the bronchial tree and abundant purulent secretions and erosions in the bronchial mucosa, with a cavitary lesion in the right bronchial tree. The bronchoalveolar lavage samples were used to isolate Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa carbapenemase class A. Matrix-assisted laser desorption/ionization–time of flight (MALDI-TOF) Biotyper mass spectrometry and polymerase chain reaction (PCR) molecular identification were performed. This case report suggested that patients with severe COVID-19 pneumonia, with or without comorbidities, are more susceptible to opportunistic infections.

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“… 12 This was recommended based on some randomized controlled studies in which its use, combined with dexamethasone, showed some benefit in terms of survival. 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A 71-Year-Old Man From Ecuador With a History of Type 2 Diabetes Mellitus and Severe COVID-19 Pneumonia and Lung Cavitation Associated With Triple Infection With Trichosporon Asahii, Klebsiella Pneumoniae, and Pseudomonas Aeruginosa

Claudett

Briones-Claudett²,

Loor³

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

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“…Tocilizumab was more selectively prescribed in the patient whose oxygen demand suddenly increased. 34 Routine use of baricitinib or tocilizumab in severe patients was hampered by concern about additional immunosuppression to that by dexamethasone, although baricitinib or tocilizumab was used more frequently in an ICU.…”

Section: Clinical Experiences and Practices For Covid-19 Treatment In...mentioning

confidence: 99%

How We Have Treated Severe to Critically Ill Patients With Coronavirus Disease 2019 in Korea

et al. 2022

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Since 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, and the coronavirus disease 2019 (COVID-19) pandemic currently continues. In response to this unprecedented pandemic, several researchers and medical staff have struggled to find appropriate treatments for COVID-19. Patients with mild symptoms can recuperate with symptomatic care, however establishing treatment for severe to critically ill patients who can have a high mortality has been essential. Accordingly, the guidelines for COVID-19 treatment have evolved through numerous trials and errors and have been relatively well established to date. In the Republic of Korea, several evidence-based guidelines for COVID-19 treatment were released and revised, reflecting various research and regional medical conditions. To date, approximately 3 years after the beginning of the COVID-19 pandemic, we are reflecting on the changes in the guidelines thus far and have summarized the treatment experience of severe to critically ill patients with COVID-19. The Korean guidelines for COVID-19 treatment have been updated continuously as the National Institutes of Health (NIH) guidelines have changed. Dexamethasone is currently used as the backbone for the treatment of severe to critically ill patients with COVID-19, and remdesivir, baricitinib, and tocilizumab can be added depending on a patient’s situation. In addition, venous thromboembolism prophylaxis is one of the important adjunctive therapies for patients with severe COVID-19. In the clinical field, treatment of severely ill patients with COVID-19 based on guidelines is widely practiced by medical staff and established currently.

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“…Сочетанная колонизация дыхательных путей микроорганизмами, одновременно преодолевающими эпителиальный барьер, может преоб-разовывать функции клеток иммунной системы, что способствует ускользанию этих патогенов от иммунного ответа. Остаются неясными особенности взаимодействия вируса SARS-CoV-2 с бактериями, разнообразие бактериально-вирусных взаимодействий при ко-инфицировании вызывает необходимость пересмотра подходов к их своевременному распознаванию и контролю, побуждает к созданию инноваций в биотехнологии и пересмотру стратегии борьбы с ко-инфицированием, развитию чего посвящены труды ученых во всем мире [9,10].…”

Section: Introductionunclassified

Viral-bacterial pneumonia in COVID-19: clinical and laboratory characteristics of patients and a spectrum of bacterial pathogens

Levchenko

Бондаренко

Mitsura

et al. 2023

jour

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Objective. To study the clinical and laboratory data of patients with viral-bacterial pneumonia caused by SARS-CoV-2, to evaluate the spectrum of bacterial causative agents and their sensitivity to antibacterial drugs.Materials and methods. 50 cases of viral-bacterial pneumonia associated with the COVID-19 infection were analyzed. The gender-age structure of patients, clinical and laboratory data, degree of disease severity and concomitant diseases were studied. Microbiological examination of sputum and bronchoalveolar lavage (BAL) was performed by bacteriological method using an automatic microbiological analyzer. Identification of the selected cultures and the determination of their sensitivity to antibacterial drugs were provided.Results. The average age of the patients in the studied group was 71,1 ± 14,8 years. 90% of patients had concomitant diseases, mainly of cardiovascular system. The secondary bacterial infection was diagnosed on 13,0 ± 5,0 day from the disease onset and was characterized by bilateral lung lesions. The most common etiological factors of bacterial pneumonia were the microorganisms of the Enterobacteriaceae family — 37%, Staphylococcus aureus — 23% and Acinetobacter baumannii — 13%. The isolated strains were characterized by drug resistance to aminopenicillins, cephalosporins, fluoroquinolones, aminoglycosides and carbapenems.Conclusion. The high level of resistance of bacterial pneumonia causative agents isolated from patients with SARS-CoV-2 infection to antimicrobial drugs requires wider use of reserve drugs and implementation of other treatment strategies.

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Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19

Cited by 7 publications

References 22 publications

A 71-Year-Old Man From Ecuador With a History of Type 2 Diabetes Mellitus and Severe COVID-19 Pneumonia and Lung Cavitation Associated With Triple Infection With Trichosporon Asahii, Klebsiella Pneumoniae, and Pseudomonas Aeruginosa

A 71-Year-Old Man From Ecuador With a History of Type 2 Diabetes Mellitus and Severe COVID-19 Pneumonia and Lung Cavitation Associated With Triple Infection With Trichosporon Asahii, Klebsiella Pneumoniae, and Pseudomonas Aeruginosa

How We Have Treated Severe to Critically Ill Patients With Coronavirus Disease 2019 in Korea

Viral-bacterial pneumonia in COVID-19: clinical and laboratory characteristics of patients and a spectrum of bacterial pathogens

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