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The Impact of Corticosteroids on Secondary Infection and Mortality in Critically Ill COVID-19 Patients.
Ritter, Lindsay A; Britton, Noel; Heil, Emily L; Teeter, William A; Murthi, Sarah B; Chow, Jonathan H; Ricotta, Emily; Chertow, Daniel S; Grazioli, Alison; Levine, Andrea R.
  • Ritter LA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Britton N; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Heil EL; Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.
  • Teeter WA; Department of Emergency Medicine, Program in Trauma/Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Murthi SB; Department of Surgery, Program in Trauma/Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Chow JH; Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine, Washington DC, USA.
  • Ricotta E; National Institute of Allergy and Infectious Diseases Division of Intramural Research, Epidemiology Unit, National Institutes of Health, Bethesda, MD, USA.
  • Chertow DS; Critical Care Medicine Department, National Institutes of Health Clinical Center and Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
  • Grazioli A; National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
  • Levine AR; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
J Intensive Care Med ; 36(10): 1201-1208, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1305547
ABSTRACT

BACKGROUND:

Corticosteroids are part of the treatment guidelines for COVID-19 and have been shown to improve mortality. However, the impact corticosteroids have on the development of secondary infection in COVID-19 is unknown. We sought to define the rate of secondary infection in critically ill patients with COVID-19 and determine the effect of corticosteroid use on mortality in critically ill patients with COVID-19. STUDY DESIGN AND

METHODS:

One hundred and thirty-five critically ill patients with COVID-19 admitted to the Intensive Care Unit (ICU) at the University of Maryland Medical Center were included in this single-center retrospective analysis. Demographics, symptoms, culture data, use of COVID-19 directed therapies, and outcomes were abstracted from the medical record. The primary outcomes were secondary infection and mortality. Proportional hazards models were used to determine the time to secondary infection and the time to death.

RESULTS:

The proportion of patients with secondary infection was 63%. The likelihood of developing secondary infection was not significantly impacted by the administration of corticosteroids (HR 1.45, CI 0.75-2.82, P = 0.28). This remained consistent in sub-analysis looking at bloodstream, respiratory, and urine infections. Secondary infection had no significant impact on the likelihood of 28-day mortality (HR 0.66, CI 0.33-1.35, P = 0.256). Corticosteroid administration significantly reduced the likelihood of 28-day mortality (HR 0.27, CI 0.10-0.72, P = 0.01).

CONCLUSION:

Corticosteroids are an important and lifesaving pharmacotherapeutic option in critically ill patients with COVID-19, which have no impact on the likelihood of developing secondary infections.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Coinfection / COVID-19 Type of study: Experimental Studies / Observational study Limits: Humans Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2021 Document Type: Article Affiliation country: 08850666211032175

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Coinfection / COVID-19 Type of study: Experimental Studies / Observational study Limits: Humans Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2021 Document Type: Article Affiliation country: 08850666211032175