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Is Tocilizumab Plus Dexamethasone Associated with Superinfection in Critically Ill COVID-19 Patients?

Background: Dexamethasone and tocilizumab are used to treat severely ill COVID-19 patients admitted to intensive care units (ICUs). We explored whether combination therapy increased the risk of superinfection compared to dexamethasone alone. Methods: This observational, retrospective study included...

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Autores principales: Camou, Fabrice, Issa, Nahéma, Hessamfar, Mojgan, Guisset, Olivier, Mourissoux, Gaëlle, Pedeboscq, Stéphane, Minot, Aimée, Bonnet, Fabrice
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9573530/
https://www.ncbi.nlm.nih.gov/pubmed/36233432
http://dx.doi.org/10.3390/jcm11195559
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author Camou, Fabrice
Issa, Nahéma
Hessamfar, Mojgan
Guisset, Olivier
Mourissoux, Gaëlle
Pedeboscq, Stéphane
Minot, Aimée
Bonnet, Fabrice
author_facet Camou, Fabrice
Issa, Nahéma
Hessamfar, Mojgan
Guisset, Olivier
Mourissoux, Gaëlle
Pedeboscq, Stéphane
Minot, Aimée
Bonnet, Fabrice
author_sort Camou, Fabrice
collection PubMed
description Background: Dexamethasone and tocilizumab are used to treat severely ill COVID-19 patients admitted to intensive care units (ICUs). We explored whether combination therapy increased the risk of superinfection compared to dexamethasone alone. Methods: This observational, retrospective study included critically ill COVID-19 adult patients admitted to our ICU because of respiratory failure. Patients received dexamethasone with (Group 1) or without (Group 2) tocilizumab. Data were collected from electronic medical files. Results: A total of 246 patients were included, of whom 150 received dexamethasone and tocilizumab, while 96 received dexamethasone alone. Acute respiratory distress syndrome was evident on admission in 226 patients, 56 of whom required mechanical ventilation (MV). Superinfections, mainly respiratory, were diagnosed in 59 patients, including 34/150 (23%) in Group 1 and 25/96 (26%) in Group 2 (p = 0.32). After multivariate analysis, the factors associated with a higher risk of superinfection included hematological malignancy (hazard ratio (HR): 2.47 (1.11–5.47), p = 0.03), MV (HR: 3.74 (1.92–7.26), p = 0.0001), and a higher SAPS-II score on admission (HR: 1.03 (1.01–1.06), p = 0.006). Conclusion: In critically ill COVID-19 patients, the addition of tocilizumab to dexamethasone was not associated with an increased risk of superinfection.
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spelling pubmed-95735302022-10-17 Is Tocilizumab Plus Dexamethasone Associated with Superinfection in Critically Ill COVID-19 Patients? Camou, Fabrice Issa, Nahéma Hessamfar, Mojgan Guisset, Olivier Mourissoux, Gaëlle Pedeboscq, Stéphane Minot, Aimée Bonnet, Fabrice J Clin Med Brief Report Background: Dexamethasone and tocilizumab are used to treat severely ill COVID-19 patients admitted to intensive care units (ICUs). We explored whether combination therapy increased the risk of superinfection compared to dexamethasone alone. Methods: This observational, retrospective study included critically ill COVID-19 adult patients admitted to our ICU because of respiratory failure. Patients received dexamethasone with (Group 1) or without (Group 2) tocilizumab. Data were collected from electronic medical files. Results: A total of 246 patients were included, of whom 150 received dexamethasone and tocilizumab, while 96 received dexamethasone alone. Acute respiratory distress syndrome was evident on admission in 226 patients, 56 of whom required mechanical ventilation (MV). Superinfections, mainly respiratory, were diagnosed in 59 patients, including 34/150 (23%) in Group 1 and 25/96 (26%) in Group 2 (p = 0.32). After multivariate analysis, the factors associated with a higher risk of superinfection included hematological malignancy (hazard ratio (HR): 2.47 (1.11–5.47), p = 0.03), MV (HR: 3.74 (1.92–7.26), p = 0.0001), and a higher SAPS-II score on admission (HR: 1.03 (1.01–1.06), p = 0.006). Conclusion: In critically ill COVID-19 patients, the addition of tocilizumab to dexamethasone was not associated with an increased risk of superinfection. MDPI 2022-09-22 /pmc/articles/PMC9573530/ /pubmed/36233432 http://dx.doi.org/10.3390/jcm11195559 Text en © 2022 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 Brief Report
Camou, Fabrice
Issa, Nahéma
Hessamfar, Mojgan
Guisset, Olivier
Mourissoux, Gaëlle
Pedeboscq, Stéphane
Minot, Aimée
Bonnet, Fabrice
Is Tocilizumab Plus Dexamethasone Associated with Superinfection in Critically Ill COVID-19 Patients?
title Is Tocilizumab Plus Dexamethasone Associated with Superinfection in Critically Ill COVID-19 Patients?
title_full Is Tocilizumab Plus Dexamethasone Associated with Superinfection in Critically Ill COVID-19 Patients?
title_fullStr Is Tocilizumab Plus Dexamethasone Associated with Superinfection in Critically Ill COVID-19 Patients?
title_full_unstemmed Is Tocilizumab Plus Dexamethasone Associated with Superinfection in Critically Ill COVID-19 Patients?
title_short Is Tocilizumab Plus Dexamethasone Associated with Superinfection in Critically Ill COVID-19 Patients?
title_sort is tocilizumab plus dexamethasone associated with superinfection in critically ill covid-19 patients?
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9573530/
https://www.ncbi.nlm.nih.gov/pubmed/36233432
http://dx.doi.org/10.3390/jcm11195559
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