Dexamethasone as risk-factor for ICU-acquired respiratory tract infections in severe COVID-19

https://doi.org/10.1016/j.jcrc.2022.154014Get rights and content
Under a Creative Commons license
open access

Highlights

  • Patients with severe COVID-19 frequently develop ICU-acquired respiratory tract infections (ICU-RTI).

  • Patients that develop ICU-RTI have a higher mortality rate.

  • Dexamethasone treatment appears to be associated with the higher ICU-RTI in severe COVID-19 patients.

Abstract

Purpose

Dexamethasone is the only drug that has consistently reduced mortality in patients with COVID-19, especially in patients needing oxygen or invasive mechanical ventilation. However, there is a growing concern about the relation of dexamethasone with the unprecedented rates of ICU-acquired respiratory tract infections (ICU-RTI) observed in patients with severe COVID-19.

Methods

This was a multicenter, prospective cohort study; conducted in ten countries in Latin America and Europe. We included patients older than 18 with confirmed SARS-CoV-2 requiring ICU admission. A multivariate logistic regression and propensity score matching (PSM) analysis was conducted to determine the relation between dexamethasone treatment and ICU-RTI.

Results

A total of 3777 patients were included. 2065 (54.7%) were treated with dexamethasone within the first 24 h of admission. After performing the PSM, patients treated with dexamethasone showed significantly higher proportions of VAP (282/1652 [17.1%] Vs. 218/1652 [13.2%], p = 0.014). Also, dexamethasone treatment was identified as an adjusted risk factor of ICU-RTI in the multivariate logistic regression model (OR 1.64; 95%CI: 1.37–1.97; p < 0.001).

Conclusion

Patients treated with dexamethasone for severe COVID-19 had a higher risk of developing ICU-acquired respiratory tract infections after adjusting for days of invasive mechanical ventilation and ICU length of stay, suggesting a cautious use of this treatment.

Keywords

Dexamethasone
COVID-19
Critical care
Severe COVID-19
Pneumonia

Abbreviations

ICU-RTI
Intensive care unit-acquired respiratory tract infections
HIV-AIDS
Human immunodeficiency virus- Acquired Immunodeficiency Disease Syndrome
PaO2
Partial arterial oxygen concentration
PaCO2
Partial arterial carbon dioxide concentration
FiO2
Inspired Fraction of Oxygen
VAP
Ventilator-Associated Pneumonia
VAT
Ventilator-Associated Tracheobronquitis
HFNC
High Flow Nasal Cannula
HAP
Hospital-acquired pneumonia
LOS
Length of stay.

Cited by (0)

1

These authors contributed equally.

2

The complete list of the LIVEN-COVID-19 and GETGAG SEMICYUC investigators are presented at the end of the manuscript.