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Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients

Background: Even though several therapeutic options are available, COVID-19 is still lacking a specific treatment regimen. One potential option is dexamethasone, which has been established since the early beginnings of the pandemic. The aim of this study was to determine its effects on the microbiol...

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Autores principales: Kodde, Cathrin, Timmen, Finja, Hohenstein, Sven, Bollmann, Andreas, Bonsignore, Marzia, Kuhlen, Ralf, Nachtigall, Irit, Tasci, Selcuk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10220814/
https://www.ncbi.nlm.nih.gov/pubmed/37243161
http://dx.doi.org/10.3390/v15051076
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author Kodde, Cathrin
Timmen, Finja
Hohenstein, Sven
Bollmann, Andreas
Bonsignore, Marzia
Kuhlen, Ralf
Nachtigall, Irit
Tasci, Selcuk
author_facet Kodde, Cathrin
Timmen, Finja
Hohenstein, Sven
Bollmann, Andreas
Bonsignore, Marzia
Kuhlen, Ralf
Nachtigall, Irit
Tasci, Selcuk
author_sort Kodde, Cathrin
collection PubMed
description Background: Even though several therapeutic options are available, COVID-19 is still lacking a specific treatment regimen. One potential option is dexamethasone, which has been established since the early beginnings of the pandemic. The aim of this study was to determine its effects on the microbiological findings in critically ill COVID-19 patients. Methods: A multi-center, retrospective study was conducted, in which all the adult patients who had a laboratory-confirmed (PCR) SARS-CoV-2 infection and were treated on intensive care units in one of twenty hospitals of the German Helios network between February 2020–March 2021 were included. Two cohorts were formed: patients who received dexamethasone and those who did not, followed by two subgroups according to the application of oxygen: invasive vs. non-invasive. Results: The study population consisted of 1.776 patients, 1070 of whom received dexamethasone, and 517 (48.3%) patients with dexamethasone were mechanically ventilated, compared to 350 (49.6%) without dexamethasone. Ventilated patients with dexamethasone were more likely to have any pathogen detection than those without (p < 0.026; OR = 1.41; 95% CI 1.04–1.91). A significantly higher risk for the respiratory detection of Klebsiella spp. (p = 0.016; OR = 1.68 95% CI 1.10–2.57) and for Enterobacterales (p = 0.008; OR = 1.57; 95% CI 1.12–2.19) was found for the dexamethasone cohort. Invasive ventilation was an independent risk factor for in-hospital mortality (p < 0.01; OR = 6.39; 95% CI 4.71–8.66). This risk increased significantly in patients aged 80 years or older by 3.3-fold (p < 0.01; OR = 3.3; 95% CI 2.02–5.37) when receiving dexamethasone. Conclusion: Our results show that the decision to treat COVID-19 patients with dexamethasone should be a matter of careful consideration as it involves risks and bacterial shifts.
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spelling pubmed-102208142023-05-28 Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients Kodde, Cathrin Timmen, Finja Hohenstein, Sven Bollmann, Andreas Bonsignore, Marzia Kuhlen, Ralf Nachtigall, Irit Tasci, Selcuk Viruses Article Background: Even though several therapeutic options are available, COVID-19 is still lacking a specific treatment regimen. One potential option is dexamethasone, which has been established since the early beginnings of the pandemic. The aim of this study was to determine its effects on the microbiological findings in critically ill COVID-19 patients. Methods: A multi-center, retrospective study was conducted, in which all the adult patients who had a laboratory-confirmed (PCR) SARS-CoV-2 infection and were treated on intensive care units in one of twenty hospitals of the German Helios network between February 2020–March 2021 were included. Two cohorts were formed: patients who received dexamethasone and those who did not, followed by two subgroups according to the application of oxygen: invasive vs. non-invasive. Results: The study population consisted of 1.776 patients, 1070 of whom received dexamethasone, and 517 (48.3%) patients with dexamethasone were mechanically ventilated, compared to 350 (49.6%) without dexamethasone. Ventilated patients with dexamethasone were more likely to have any pathogen detection than those without (p < 0.026; OR = 1.41; 95% CI 1.04–1.91). A significantly higher risk for the respiratory detection of Klebsiella spp. (p = 0.016; OR = 1.68 95% CI 1.10–2.57) and for Enterobacterales (p = 0.008; OR = 1.57; 95% CI 1.12–2.19) was found for the dexamethasone cohort. Invasive ventilation was an independent risk factor for in-hospital mortality (p < 0.01; OR = 6.39; 95% CI 4.71–8.66). This risk increased significantly in patients aged 80 years or older by 3.3-fold (p < 0.01; OR = 3.3; 95% CI 2.02–5.37) when receiving dexamethasone. Conclusion: Our results show that the decision to treat COVID-19 patients with dexamethasone should be a matter of careful consideration as it involves risks and bacterial shifts. MDPI 2023-04-28 /pmc/articles/PMC10220814/ /pubmed/37243161 http://dx.doi.org/10.3390/v15051076 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kodde, Cathrin
Timmen, Finja
Hohenstein, Sven
Bollmann, Andreas
Bonsignore, Marzia
Kuhlen, Ralf
Nachtigall, Irit
Tasci, Selcuk
Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients
title Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients
title_full Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients
title_fullStr Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients
title_full_unstemmed Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients
title_short Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients
title_sort impact of dexamethasone on the pathogen profile of critically ill covid-19 patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10220814/
https://www.ncbi.nlm.nih.gov/pubmed/37243161
http://dx.doi.org/10.3390/v15051076
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