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The association between early corticosteroid use and the risk of secondary infections in hospitalized patients with

Vikas Bansal1, Nitesh K Jain2,3, Amos Lal3

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Early corticosteroid use in hospitalized COVID-19 patients increases secondary infection risk, particularly bacteremia. The impact on other infections like bacterial pneumonia and meningitis varies, necessitating further research for optimized treatment strategies.

Keywords:
COVID-19SARS-CoV-2VIRUS COVID-19 registrycorticosteroidsearly steroid treatment outcomeshospitalized patientsrisk factorssecondary infections

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Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Pharmacology

Background:

  • Corticosteroids are known to improve survival in hospitalized COVID-19 patients requiring supplemental oxygen.
  • However, concerns exist regarding the potential for increased secondary infections with corticosteroid use.
  • This study aimed to investigate the specific impact of early corticosteroid administration on secondary infection development in COVID-19 patients.

Purpose of the Study:

  • To determine the association between early corticosteroid use (within 48 hours of admission) and the incidence of secondary bacterial infections in hospitalized COVID-19 patients.
  • To analyze the impact of early corticosteroids on specific types of secondary infections, including bacteremia, bacterial pneumonia, meningitis/encephalitis, septic shock, and ventilator-associated pneumonia (VAP).

Main Methods:

  • Analysis of data from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 registry.
  • Inclusion of 17,092 adult patients, stratified by early corticosteroid use.
  • Utilized univariate and multivariable logistic regression to assess the association between early corticosteroid use and documented secondary infections.

Main Results:

  • 13.5% of patients developed at least one secondary bacterial infection.
  • Early corticosteroid use was associated with a higher risk of overall secondary infections (adjusted OR 1.15) and bacteremia (adjusted OR 1.43).
  • The association with bacterial pneumonia and septic shock weakened after adjustment, while a reduced risk for meningitis/encephalitis was observed (adjusted OR 0.26).

Conclusions:

  • Early corticosteroid administration in hospitalized COVID-19 patients is linked to an increased risk of overall secondary infections, with a notable rise in bacteremia.
  • The specific impact on different secondary infections varies, with adjusted analyses showing non-significant associations for bacterial pneumonia and septic shock, and a surprising reduction in meningitis/encephalitis risk.
  • Further research is crucial to elucidate the complex mechanisms by which corticosteroids influence specific secondary infections and to refine treatment guidelines for COVID-19 management.