Impact of Dexamethasone on pathogen profile of COVID19 patients requiring intensive care: a multicentre retrospective study

ABSTRACT

Background: The use of dexamethasone improved the outcome among hospitalized patients with Covid-19 since mid-2020 significantly (Horby et al.). However, there remain concerns about an increase of bacterial and fungal growth especially in critical ill patients. Aims and objectives: Aim of our study was to identify the bacterial and fungal pathogens dependent on the use of dexamethasone as a treatment of COVID-19 patients admitted to the intensive care unit (ICU). Studies show that bacterial and fungal co-infections raised during the pandemic due to increased empirical antibiotic use for COVID-19 pneumonia. The effect of dexamethasone has not been in focus. Method(s) For this study, we included all patients who had a lab-confirmed SARS-CoV-2 infection treated on the ICU. The clinical data was collected onsite in 20 hospitals of the German Helios-network between February 2020 and March 2021 and aligned with corresponding claims data. We performed a univariate and multivariate analyses to identify the impact of dexamethasone versus no dexamethasone on the pathogen profile in bloodstream and respiratory infections. Result(s) Out of 1 776 patients included, 1070 were treated with dexamethasone. Those patients were more likely to have an infection with Staphyloccus spp., Candida spp., E. coli, Klebsiella spp. and multidrug resistant bacteria (MRE) compared to patients without dexamethasone treatment. However, no change in the absolute number of detected pathogens was observed. Conclusion(s) Dexamethasone leads to a shift of bacterial and fungal pathogens in ICU-treated COVID-19 patients. This shift should be considered when empirical antibiotic therapy is administered.