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Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation.
Søvik, Signe; Barrat-Due, Andreas; Kåsine, Trine; Olasveengen, Theresa; Strand, Marianne Wigernes; Tveita, Anders Aune; Berdal, Jan Erik; Lehre, Martin Andreas; Lorentsen, Torleif; Heggelund, Lars; Stenstad, Tore; Ringstad, Jetmund; Müller, Fredrik; Aukrust, Pål; Holter, Jan Cato; Nordøy, Ingvild.
  • Søvik S; Dept. of Anesthesiology and Intensive Care, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: signe.sovik@medisin.uio.no.
  • Barrat-Due A; Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Dept. of Immunology, Oslo University Hospital, Oslo, Norway. Electronic address: abarratt@ous-hf.no.
  • Kåsine T; Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: TRIKAA@ous-hf.no.
  • Olasveengen T; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: uxothe@ous-hf.no.
  • Strand MW; Dept. of Infectious Diseases, Østfold Hospital, Kalnes, Norway Marianne. Wigernes. Electronic address: Strand@so-hf.no.
  • Tveita AA; Dept. of Internal Medicine, Vestre Viken Hospital Trust, Bærum, Norway; Dept. of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway. Electronic address: a.a.tveita@medisin.uio.no.
  • Berdal JE; Dept. of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: Jan-Erik.Berdal@ahus.no.
  • Lehre MA; Dept. of Anesthesiology and Intensive Care, Akershus University Hospital, Lørenskog, Norway. Electronic address: martin.andreas.lehre@ahus.no.
  • Lorentsen T; Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: torlor@ous-hf.no.
  • Heggelund L; Dept. of Internal Medicine, Vestre Viken Hospital Trust, Drammen, Drammen, Norway; Dept. of Clinical Science, Faculty of Medicine, University of Bergen, Norway. Electronic address: lars.heggelund@vestreviken.no.
  • Stenstad T; Dept. of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway. Electronic address: tore.stenstad@siv.no.
  • Ringstad J; Dept. of Internal Medicine, Vestre Viken Hospital Trust, Bærum, Norway. Electronic address: Jetmund.Ringstad@so-hf.no.
  • Müller F; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Microbiology, Oslo University Hospital, Oslo, Norway. Electronic address: fmuller@ous-hf.no.
  • Aukrust P; Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway; Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. Electronic address: paukrust@ous-hf.no.
  • Holter JC; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Microbiology, Oslo University Hospital, Oslo, Norway. Electronic address: jacaho@ous-hf.no.
  • Nordøy I; Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway; Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. Electronic address: inordoy@ous-hf.no.
J Infect ; 85(1): 57-63, 2022 07.
Article in English | MEDLINE | ID: covidwho-1851543
ABSTRACT

OBJECTIVES:

To determine the incidence and characteristics of superinfections in mechanically ventilated COVID-19 patients, and the impact of dexamethasone as standard therapy.

METHODS:

This multicentre, observational, retrospective study included patients ≥ 18 years admitted from March 1st 2020 to January 31st 2021 with COVID-19 infection who received mechanical ventilation. Patient characteristics, clinical characteristics, therapy and survival were examined.

RESULTS:

155/156 patients (115 men, mean age 62 years, range 26-84 years) were included. 67 patients (43%) had 90 superinfections, pneumonia dominated (78%). Superinfections were associated with receiving dexamethasone (66% vs 32%, p<0.0001), autoimmune disease (18% vs 5.7%, p<0.016) and with longer ICU stays (26 vs 17 days, p<0,001). Invasive fungal infections were reported exclusively in dexamethasone-treated patients [8/67 (12%) vs 0/88 (0%), p<0.0001]. Unadjusted 90-day survival did not differ between patients with or without superinfections (64% vs 73%, p=0.25), but was lower in patients receiving dexamethasone versus not (58% vs 78%, p=0.007). In multiple regression analysis, superinfection was associated with dexamethasone use [OR 3.7 (1.80-7.61), p<0.001], pre-existing autoimmune disease [OR 3.82 (1.13-12.9), p=0.031] and length of ICU stay [OR 1.05 p<0.001].

CONCLUSIONS:

In critically ill COVID-19 patients, dexamethasone as standard of care was strongly and independently associated with superinfections.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Autoimmune Diseases / Superinfection / COVID-19 Type of study: Observational study / Prognostic study Limits: Adult / Aged / Humans / Male / Middle aged Language: English Journal: J Infect Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Autoimmune Diseases / Superinfection / COVID-19 Type of study: Observational study / Prognostic study Limits: Adult / Aged / Humans / Male / Middle aged Language: English Journal: J Infect Year: 2022 Document Type: Article