尽管COVID-19感染是一种免疫抑制剂疾病,许多免疫抑制剂,如脉冲甲基强的松龙(PMP),地塞米松(DXM),和托珠单抗(TCZ),在大流行期间使用。最近报道了COVID-19患者的继发感染。这项研究调查了这些药物对重症监护病房(ICU)COVID-19患者继发感染和预后的影响。这项研究是回顾性设计的,所有数据均在2020年3月至2021年10月期间从6家医院的三级重症监护病房收集。所有患者分为三组:I组[GI,PMP(-),DXM(-)和TCZ(-)],第二组[GII,PMP(+),DXM(+)],和第三组[GIII,PMP(+),DXM(+),TCZ(+)].人口统计数据,PaO/FiO2比值,实验室参数,文化结果,并记录结果。要比较GI-GII和GI-GIII,通过匹配14个参数使用倾向评分匹配(PSM).该研究纳入了ICU中的412例COVID-19患者。微生物≥2例患者为279例(67.7%)。PSM之后,在GII和GIII中,在ICU期间检测到不同微生物的(+)气管培养物和(+)血流培养物的数量≥2,神经病,气管切开的患者,IMV的持续时间,ICU住院时间明显高于GI。GI和GII的死亡率相似,而GIII明显高于GI。在COVID-19患者中使用免疫抑制剂可能导致继发感染增加。此外,继发感染增加可能导致ICU住院时间延长,IMV持续时间延长,和死亡率增加。
Although COVID-19 infection is an immunosuppressant disease, many immunosuppressant agents, such as pulse methylprednisolone (PMP), dexamethasone (DXM), and tocilizumab (TCZ), were used during the pandemic.
Secondary infections in patients with COVID-19 have been reported recently. This study investigated these agents\' effects on
secondary infections and outcomes in patients with COVID-19 in intensive care units (ICUs). This study was designed retrospectively, and all data were collected from the tertiary intensive care units of six hospitals between March 2020 and October 2021. All patients were divided into three groups: Group I [GI, PMP (-), DXM (-) and TCZ (-)], Group II [GII, PMP (+), DXM (+)], and Group III [GIII, PMP (+), DXM (+), TCZ (+)]. Demographic data, PaO/FiO2 ratio, laboratory parameters, culture results, and outcomes were recorded. To compare GI-GII and GI-GIII, propensity score matching (PSM) was used by matching 14 parameters. Four hundred twelve patients with COVID-19 in the ICU were included in the study. The number of patients with microorganisms ≥ 2 was 279 (67.7%). After PSM, in GII and GIII, the number of (+) tracheal cultures and (+) bloodstream cultures detected different microorganisms ≥ 2 during the ICU period, neuropathy, tracheotomized patients, duration of IMV, and length of ICU stay were significantly higher than GI. The mortality rate was similar in GI and GII, whereas it was significantly higher in GIII than in GI. The use of immunosuppressant agents in COVID-19 patients may lead to an increase in
secondary infections. In addition, increased
secondary infections may lead to prolonged ICU stay, prolonged IMV duration, and increased mortality.