Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation

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 1 st 2020 to January 31 st 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 < 0.0 0 01), 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 < 0.0 0 01]. 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. (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Automated summary

Dexamethasone use in mechanically ventilated COVID-19 patients is strongly associated with superinfections, as well as pre-existing autoimmune disease and longer ICU stays. While superinfections do not impact 90-day survival, patients receiving dexamethasone have lower survival rates.