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Year 2022, Volume: 5 Issue: 5, 1252 - 1258, 25.09.2022
https://doi.org/10.32322/jhsm.1136479

Abstract

References

  • World Health Organization. WHO coronavirus (COVID-19) dashboard. Available from: https://covid19.who.int/ cited on 28 May 2022.
  • Russo A, Olivadese V, Trecarichi EM, Torti C. Bacterial ventilator-associated pneumonia in COVID-19 patients: data from the second and third waves of the pandemic. J Clin Med 2022; 11: 2279.
  • Gustine JN, Jones D. Immunopathology of hyperinflammation in COVID-19. Am J Pathol 2021; 191: 4-17.
  • Sahin Ozdemirel T, Akkurt ES, Ertan O, Gokler ME, Akıncı Ozyurek B. Complications with moderate-to-severe COVID-19 during hospital admissions in patients with pneumonia. J Health Sci Med 2021; 4: 766-71.
  • Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J 2017; 50: 1700582.
  • World Health Organization. Therapeutics and COVID-19: living guideline. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2022.3. cited on 28 May 2022.
  • REMAP-CAP Investigators, Gordon AC, Mouncey PR, et al. Interleukin-6 receptor antagonists in critically ill patients with COVID-19. N Engl J Med 2021; 384: 1491-502.
  • Rosas IO, Bräu N, Waters M, et al. Tocilizumab in hospitalized patients with severe COVID-19 pneumonia. N Engl J Med 2021; 384: 1503-16.
  • Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care 2021; 25: 25.
  • Meawed TE, Ahmed SM, Mowafy SMS, Samir GM, Anis RH. Bacterial and fungal ventilator associated pneumonia in critically ill COVID-19 patients during the second wave. J Infect Public Health 2021; 14: 1375-80.
  • Kalil AC, Metersky ML, Klompas M, et al. Executive summary: management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63: 575-82.
  • Pawlik J, Tomaszek L, Mazurek H, Mędrzycka-Dąbrowska W. Risk factors and protective factors against ventilator-associated pneumonia- a single-center mixed prospective and retrospective cohort study. J Pers Med 2022; 12: 597.
  • Basak S, Singh P, Rajurkar M. Multidrug resistant and extensively drug resistant bacteria: a study. J Pathog 2016; 2016: 4065603.
  • Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033-4.
  • Somers EC, Eschenauer GA, Troost JP, et al. Tocilizumab for treatment of mechanically ventilated patients with COVID-19. Clin Infect Dis 2021; 73: e445-54.
  • RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med 2021; 384: 693-704.
  • Ramiro S, Mostard RLM, Magro-Checa C, et al. Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study. Ann Rheum Dis 2020; 79: 1143-51.
  • Ippolito M, Misseri G, Catalisano G, et al. Ventilator-associated pneumonia in patients with COVID-19: a systematic review and meta-analysis. Antibiotics (Basel) 2021; 10: 545.
  • Martínez-Martínez M, Plata-Menchaca EP, Nuvials FX, Roca O, Ferrer R. Risk factors and outcomes of ventilator-associated pneumonia in COVID-19 patients: a propensity score matched analysis. Crit Care 2021; 25: 235.
  • Roumier M, Paule R, Vallée A, et al. Tocilizumab for severe worsening COVID-19 pneumonia: a propensity score analysis. J Clin Immunol 2021; 41: 303-14.
  • Gragueb-Chatti I, Lopez A, Hamidi D, et al. Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study. Ann Intensive Care 2021; 11: 87.
  • Stone JH, Frigault MJ, Serling-Boyd NJ, et al. Efficacy of tocilizumab in patients hospitalized with COVID-19. N Engl J Med 2020; 383: 2333-44.
  • Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX randomized clinical trial. JAMA 2020; 324: 1307-16.
  • Naik NB, Puri GD, Kajal K, et al. High-dose dexamethasone versus tocilizumab in moderate to severe COVID-19 pneumonia: a randomized controlled trial. Cureus 2021; 13: e20353.
  • Lima WG, Brito JCM, da Cruz Nizer WS. Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii in patients with COVID-19: two problems, one solution? Med Hypotheses 2020; 144: 110139.
  • Giacobbe DR, Battaglini D, Enrile EM, et al. Incidence and prognosis of ventilator-associated pneumonia in critically ill patients with COVID-19: a multicenter study. J Clin Med 2021; 10: 555.
  • Baiou A, Elbuzidi AA, Bakdach D, et al. Clinical characteristics and risk factors for the isolation of multi-drug-resistant gram-negative bacteria from critically ill patients with COVID-19. J Hosp Infect 2021; 110: 165-71.
  • Karatas M, Yasar-Duman M, Tunger A, Cilli F, Aydemir S, Ozenci V. Secondary bacterial infections and antimicrobial resistance in COVID-19: comparative evaluation of pre-pandemic and pandemic-era, a retrospective single center study. Ann Clin Microbiol Antimicrob 2021; 20: 51.
  • Póvoa HCC, Chianca GC, Iorio NLPP. COVID-19: an alert to ventilator-associated bacterial pneumonia. Infect Dis Ther 2020; 9: 417-20.
  • Bentivegna E, Luciani M, Arcari L, Santino I, Simmaco M, Martelletti P. Reduction of multidrug-resistant (MDR) bacterial infections during the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health 2021; 18: 1003.

The effect of immunosuppressive therapy on the development of ventilator-associated pneumonia in patients with COVID-19

Year 2022, Volume: 5 Issue: 5, 1252 - 1258, 25.09.2022
https://doi.org/10.32322/jhsm.1136479

Abstract

Aim: It remains unclear whether immunosuppressive treatments such as corticosteroids and IL-6 receptor blockers have an effect on the development of ventilator-associated pneumonia (VAP). The aim of this study was to investigate the effect of immunosuppressive therapy on the development of VAP in critically ill patients with COVID-19.
Material and Method: Two hundred thirty five patients with critically ill patients with COVID-19, who were treated in the intensive care unit (ICU) and received mechanical ventilator support, were evaluated retrospectively. VAP development, secondary infections, microorganisms isolated, and resistance patterns were compared between the groups that received and did not receive immunosuppressive therapy, and also the groups that did not receive immunosuppressive therapy, received only corticosteroid, received only tocilizumab, and received corticosteroid plus tocilizumab were compared in the subgroup analysis.
Results: In the immunosuppressive treatment group, VAP development (40.2% vs. 21.2%; p=0.001), secondary infection development (48.4% vs. 29.2%; p=0.003), at least one drug resistant bacteria growth (46.7% vs. 27.4%; p=0.001), extensively-drug resistant (XDR) microorganism growth (89.8% vs. 72.7%; p=0.033) were higher than the group that did not receive immunosuppressive treatment. VAP (53.3%; p=0.004), secondary infection (73.3%; p=0.0002), the growth of bacteria resistant to at least one drug (70%; p=0.0003) were highest in the corticosteroid plus tocilizumab group in the subgroup analysis. In addition, XDR (95.5% vs. 72.7%; p=0.032) and pan-drug resistant (PDR) microorganism growth (31.8% vs. 9.1% p=0.032) were higher in the corticosteroid plus tocilizumab group than the no immunosuppressive therapy group. There was no difference between the groups in terms of mortality (p>0.05).
Conclusion: Immunosuppressive therapy has been found to potentially enhance the risk of VAP and secondary infections in critically ill patients with COVID-19 pneumonia as well as the growth of bacteria resistant to at least one drug, the length of stay in hospital and ICUs. In addition, it has been evaluated that there may be an increase in the growth of XDR and PDR microorganisms when corticosteroid and tocilizumab are used together. Although there was no difference in mortality, using immunosuppressive therapy may require careful use of targeted antibiotics and longer-term antimicrobial therapy.

References

  • World Health Organization. WHO coronavirus (COVID-19) dashboard. Available from: https://covid19.who.int/ cited on 28 May 2022.
  • Russo A, Olivadese V, Trecarichi EM, Torti C. Bacterial ventilator-associated pneumonia in COVID-19 patients: data from the second and third waves of the pandemic. J Clin Med 2022; 11: 2279.
  • Gustine JN, Jones D. Immunopathology of hyperinflammation in COVID-19. Am J Pathol 2021; 191: 4-17.
  • Sahin Ozdemirel T, Akkurt ES, Ertan O, Gokler ME, Akıncı Ozyurek B. Complications with moderate-to-severe COVID-19 during hospital admissions in patients with pneumonia. J Health Sci Med 2021; 4: 766-71.
  • Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J 2017; 50: 1700582.
  • World Health Organization. Therapeutics and COVID-19: living guideline. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2022.3. cited on 28 May 2022.
  • REMAP-CAP Investigators, Gordon AC, Mouncey PR, et al. Interleukin-6 receptor antagonists in critically ill patients with COVID-19. N Engl J Med 2021; 384: 1491-502.
  • Rosas IO, Bräu N, Waters M, et al. Tocilizumab in hospitalized patients with severe COVID-19 pneumonia. N Engl J Med 2021; 384: 1503-16.
  • Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care 2021; 25: 25.
  • Meawed TE, Ahmed SM, Mowafy SMS, Samir GM, Anis RH. Bacterial and fungal ventilator associated pneumonia in critically ill COVID-19 patients during the second wave. J Infect Public Health 2021; 14: 1375-80.
  • Kalil AC, Metersky ML, Klompas M, et al. Executive summary: management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63: 575-82.
  • Pawlik J, Tomaszek L, Mazurek H, Mędrzycka-Dąbrowska W. Risk factors and protective factors against ventilator-associated pneumonia- a single-center mixed prospective and retrospective cohort study. J Pers Med 2022; 12: 597.
  • Basak S, Singh P, Rajurkar M. Multidrug resistant and extensively drug resistant bacteria: a study. J Pathog 2016; 2016: 4065603.
  • Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033-4.
  • Somers EC, Eschenauer GA, Troost JP, et al. Tocilizumab for treatment of mechanically ventilated patients with COVID-19. Clin Infect Dis 2021; 73: e445-54.
  • RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med 2021; 384: 693-704.
  • Ramiro S, Mostard RLM, Magro-Checa C, et al. Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study. Ann Rheum Dis 2020; 79: 1143-51.
  • Ippolito M, Misseri G, Catalisano G, et al. Ventilator-associated pneumonia in patients with COVID-19: a systematic review and meta-analysis. Antibiotics (Basel) 2021; 10: 545.
  • Martínez-Martínez M, Plata-Menchaca EP, Nuvials FX, Roca O, Ferrer R. Risk factors and outcomes of ventilator-associated pneumonia in COVID-19 patients: a propensity score matched analysis. Crit Care 2021; 25: 235.
  • Roumier M, Paule R, Vallée A, et al. Tocilizumab for severe worsening COVID-19 pneumonia: a propensity score analysis. J Clin Immunol 2021; 41: 303-14.
  • Gragueb-Chatti I, Lopez A, Hamidi D, et al. Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study. Ann Intensive Care 2021; 11: 87.
  • Stone JH, Frigault MJ, Serling-Boyd NJ, et al. Efficacy of tocilizumab in patients hospitalized with COVID-19. N Engl J Med 2020; 383: 2333-44.
  • Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX randomized clinical trial. JAMA 2020; 324: 1307-16.
  • Naik NB, Puri GD, Kajal K, et al. High-dose dexamethasone versus tocilizumab in moderate to severe COVID-19 pneumonia: a randomized controlled trial. Cureus 2021; 13: e20353.
  • Lima WG, Brito JCM, da Cruz Nizer WS. Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii in patients with COVID-19: two problems, one solution? Med Hypotheses 2020; 144: 110139.
  • Giacobbe DR, Battaglini D, Enrile EM, et al. Incidence and prognosis of ventilator-associated pneumonia in critically ill patients with COVID-19: a multicenter study. J Clin Med 2021; 10: 555.
  • Baiou A, Elbuzidi AA, Bakdach D, et al. Clinical characteristics and risk factors for the isolation of multi-drug-resistant gram-negative bacteria from critically ill patients with COVID-19. J Hosp Infect 2021; 110: 165-71.
  • Karatas M, Yasar-Duman M, Tunger A, Cilli F, Aydemir S, Ozenci V. Secondary bacterial infections and antimicrobial resistance in COVID-19: comparative evaluation of pre-pandemic and pandemic-era, a retrospective single center study. Ann Clin Microbiol Antimicrob 2021; 20: 51.
  • Póvoa HCC, Chianca GC, Iorio NLPP. COVID-19: an alert to ventilator-associated bacterial pneumonia. Infect Dis Ther 2020; 9: 417-20.
  • Bentivegna E, Luciani M, Arcari L, Santino I, Simmaco M, Martelletti P. Reduction of multidrug-resistant (MDR) bacterial infections during the COVID-19 pandemic: a retrospective study. Int J Environ Res Public Health 2021; 18: 1003.
There are 30 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Kadir Canoğlu 0000-0003-1579-3392

Omer Ayten 0000-0002-2275-4378

Publication Date September 25, 2022
Published in Issue Year 2022 Volume: 5 Issue: 5

Cite

AMA Canoğlu K, Ayten O. The effect of immunosuppressive therapy on the development of ventilator-associated pneumonia in patients with COVID-19. J Health Sci Med / JHSM. September 2022;5(5):1252-1258. doi:10.32322/jhsm.1136479

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