Abstract
BackgroundDexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality.ResultsAmong the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups.ConclusionsIn this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.
Highlights
Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic
Demographic characteristics, comorbidities, severity at intensive care unit (ICU) admission, date of COVID-19 first symptoms and Reverse transcription polymerase chain reaction (RT-PCR) positivity, date of ICU admission, date of intubation and invasive mechanical ventilation (MV), need for extracorporeal membrane oxygenation (ECMO), antiviral treatment, initial bacterial co-infection and antibiotics received at ICU admission, nosocomial infections (VAP and blood stream infections (BSI)) with microbiological documentation and recurrences, duration of invasive MV, ICU and hospital stay, status at day 28, day 90, ICU and hospital mortality were obtained
Dexamethasone was administered before the period at risk of ventilator-associated pneumonia (VAP) or BSI
Summary
Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. We con‐ ducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Among patients admitted to the intensive care unit (ICU) with a severe form of coronavirus disease 2019 (COVID19), up to 80% [1] require invasive mechanical ventilation (MV). The mortality of these patients has been reported to be as high as 37% [1]. We compared the duration of MV, length of stay and mortality according to the use of dexamethasone
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