Impact of dexamethasone on the incidence of ventilator-associated pneumonia in mechanically ventilated COVID-19 patients: a propensity-matched cohort study

Objective To assess the impact of treatment with steroids on the incidence and outcome of ventilator-associated pneumonia (VAP) in mechanically ventilated COVID-19 patients. Design Propensity-matched retrospective cohort study from February 24 to December 31, 2020, in 4 dedicated COVID-19 Intensive...

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Vydané v:Critical care (London, England) Ročník 26; číslo 1; s. 176 - 5
Hlavní autori: Scaravilli, Vittorio, Guzzardella, Amedeo, Madotto, Fabiana, Beltrama, Virginia, Muscatello, Antonio, Bellani, Giacomo, Monti, Gianpaola, Greco, Massimiliano, Pesenti, Antonio, Bandera, Alessandra, Grasselli, Giacomo
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: London BioMed Central 13.06.2022
BioMed Central Ltd
Springer Nature B.V
BMC
Predmet:
Adult
Antibiotics
Artificial respiration
Bacteria
Brief Report
Cohort analysis
Cohort Studies
Comorbidity
Complications and side effects
Confidence intervals
Coronaviruses
Corticosteroids
COVID-19
COVID-19 - epidemiology
COVID-19 Drug Treatment
Critical care
Critical Care Medicine
Dexamethasone
Dexamethasone - therapeutic use
Dosage and administration
Drug dosages
Drug therapy
Emergency Medicine
Hospital-acquired infections
Humans
Immunosuppressive agents
Incidence
Intensive
Intensive care unit
Intensive Care Units
Intubation
Length of stay
Medicine
Medicine & Public Health
Mortality
Nosocomial infections
Patient outcomes
Patients
Pneumonia
Pneumonia, Ventilator-Associated - drug therapy
Pneumonia, Ventilator-Associated - epidemiology
Pneumonia, Ventilator-Associated - etiology
Respiration, Artificial - adverse effects
Respiratory distress syndrome
Retrospective Studies
Risk assessment
Risk factors
Severe acute respiratory syndrome coronavirus 2
Steroids
Ventilator-associated pneumonia
Ventilators
Italy
COVID-19
Critical care
Ventilator-associated pneumonia
Corticosteroids
Hospital-acquired infections
Intensive care unit
ISSN:1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Shrnutí:Objective To assess the impact of treatment with steroids on the incidence and outcome of ventilator-associated pneumonia (VAP) in mechanically ventilated COVID-19 patients. Design Propensity-matched retrospective cohort study from February 24 to December 31, 2020, in 4 dedicated COVID-19 Intensive Care Units (ICU) in Lombardy (Italy). Patients Adult consecutive mechanically ventilated COVID-19 patients were subdivided into two groups: (1) treated with low-dose corticosteroids (dexamethasone 6 mg/day intravenous for 10 days) (DEXA+); (2) not treated with corticosteroids (DEXA−). A propensity score matching procedure (1:1 ratio) identified patients' cohorts based on: age, weight, PEEP Level, PaO 2 /FiO 2 ratio, non-respiratory Sequential Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), C reactive protein plasma concentration at admission, sex and admission hospital (exact matching). Intervention Dexamethasone 6 mg/day intravenous for 10 days from hospital admission. Measurements and main results Seven hundred and thirty-nine patients were included, and the propensity-score matching identified two groups of 158 subjects each. Eighty-nine (56%) DEXA+ versus 55 (34%) DEXA− patients developed a VAP (RR 1.61 (1.26–2.098), p  = 0.0001), after similar time from hospitalization, ICU admission and intubation. DEXA+ patients had higher crude VAP incidence rate (49.58 (49.26–49.91) vs. 31.65 (31.38–31.91)VAP*1000/pd), (IRR 1.57 (1.55–1.58), p  < 0.0001) and risk for VAP (HR 1.81 (1.31–2.50), p  = 0.0003), with longer ICU LOS and invasive mechanical ventilation but similar mortality (RR 1.17 (0.85–1.63), p  = 0.3332). VAPs were similarly due to G+ bacteria (mostly Staphylococcus aureus) and G− bacteria (mostly Enterobacterales). Forty-one (28%) VAPs were due to multi-drug resistant bacteria. VAP was associated with almost doubled ICU and hospital LOS and invasive mechanical ventilation, and increased mortality (RR 1.64 [1.02–2.65], p  = 0.040) with no differences among patients' groups. Conclusions Critically ill COVID-19 patients are at high risk for VAP, frequently caused by multidrug-resistant bacteria, and the risk is increased by corticosteroid treatment. Trial registration : NCT04388670, retrospectively registered May 14, 2020.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:1364-8535
1466-609X
1364-8535
1466-609X
1366-609X
DOI:10.1186/s13054-022-04049-2