Corticosteroids Use and Risk of Respiratory Coinfections in Mechanically Ventilated Patients With COVID-19

Abstract

Background To describe respiratory coinfections, predictive factors and outcomes in patients requiring mechanical ventilation (MV) with COVID-19. Methods Cohort study, carried out in a Chilean single tertiary Hospital. All patients with COVID-19 admitted to ICU that required MV were included between 1 June and 31 July 2020. Results 175 patients were admitted to ICU and required MV. Of these, 71 patients developed at least one respiratory coinfection (40.6 %). Early coinfections and late coinfections were diagnosed in 1.7% and 31.4% of all patients admitted to ICU respectively. Within late coinfections, 88% were bacterial, 10% were fungal, and 2% were viral coinfections. One third of isolated bacteria were multidrug-resistant. Multivariate analysis showed that the risk for coinfection was 7.7 times higher for patients with history of corticosteroids (adOR = 7.65, CI 95%: 1.04-56.2, p=0,046) and 2.7 times higher for patients that received dexamethasone during hospitalization (adOR=2.69; CI 95%: 1.14-6.35, p=0,024) than patients that were not exposed. For each additional day in MV, the risk of coinfection increases 1.1 times (adOR=1.06; CI 95%: 1.01-1.11, p=0,025). Conclusions Patients in ICU with COVID-19 that require MV had a high rate of coinfections during their stay, but not at admission. Major predisposing factors are the history of corticosteroids, the use of dexamethasone during hospitalization and days in MV.

COVID-19 Pnömonili Hastaların Solunum Yolu Örneklerinde Sekonder Bakteriyel Ajanlar ve Antibiyotik Direnç Profilleri

“…Whereas growth detection in the third quadrant was classified as "many". BAL samples were included in the study if there was >10 4 CFU/ mL growth in the medium. Specimens with growth in culture were identified at the species level by conventional methods, such as gram staining and colony morphology, using an automated system (VITEK2 automated system, bioMérieux, France).…”

“…One of these is that the disease causes acute respiratory failure, leading to the need for mechanical ventilation. 3,4 Another reason is that SARS-CoV-2 can destroy the respiratory tract epithelium or can alter the normal respiratory tract microbiota due to microbial migration. These effects disrupt the flora and predispose patients to be secondary bacterial and/or fungal coinfections associated with high mortality.…”