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

Signe Søvik; Andreas Barrat-Due; Trine Kåsine; Theresa Olasveengen; Marianne Wigernes Strand; Anders Aune Tveita; Jan Erik Berdal; Martin Andreas Lehre; Torleif Lorentsen; Lars Heggelund; Tore Stenstad; Jetmund Ringstad; Fredrik Müller; Pål Aukrust; Jan Cato Holter; Ingvild Nordøy

doi:10.1016/j.jinf.2022.05.015

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

J Infect. 2022 Jul;85(1):57-63. doi: 10.1016/j.jinf.2022.05.015. Epub 2022 May 21.

Authors

Signe Søvik¹, Andreas Barrat-Due², Trine Kåsine³, Theresa Olasveengen⁴, Marianne Wigernes Strand⁵, Anders Aune Tveita⁶, Jan Erik Berdal⁷, Martin Andreas Lehre⁸, Torleif Lorentsen⁹, Lars Heggelund¹⁰, Tore Stenstad¹¹, Jetmund Ringstad¹², Fredrik Müller¹³, Pål Aukrust¹⁴, Jan Cato Holter¹⁵, Ingvild Nordøy¹⁶

Affiliations

¹ 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.
² 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.
³ Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: TRIKAA@ous-hf.no.
⁴ 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.
⁵ Dept. of Infectious Diseases, Østfold Hospital, Kalnes, Norway Marianne. Wigernes. Electronic address: Strand@so-hf.no.
⁶ 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.
⁷ 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.
⁸ Dept. of Anesthesiology and Intensive Care, Akershus University Hospital, Lørenskog, Norway. Electronic address: martin.andreas.lehre@ahus.no.
⁹ Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: torlor@ous-hf.no.
¹⁰ 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.
¹¹ Dept. of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway. Electronic address: tore.stenstad@siv.no.
¹² Dept. of Internal Medicine, Vestre Viken Hospital Trust, Bærum, Norway. Electronic address: Jetmund.Ringstad@so-hf.no.
¹³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Microbiology, Oslo University Hospital, Oslo, Norway. Electronic address: fmuller@ous-hf.no.
¹⁴ 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.
¹⁵ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Microbiology, Oslo University Hospital, Oslo, Norway. Electronic address: jacaho@ous-hf.no.
¹⁶ 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.

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 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<0.0001), 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.

Keywords: ARDS; COVID-19; Dexamethasone; Invasive fungal infections; Superinfections.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / adverse effects
Adult
Aged
Aged, 80 and over
Autoimmune Diseases* / etiology
COVID-19*
Dexamethasone / adverse effects
Humans
Male
Middle Aged
Respiration, Artificial
Retrospective Studies
SARS-CoV-2
Superinfection* / etiology

Substances

Adrenal Cortex Hormones
Dexamethasone