Dexamethasone as risk-factor for ICU-acquired respiratory tract infections in severe COVID-19
Luis Felipe Reyes, Alejandro Rodríguez, Alirio Bastidas, Daniela Parra-Tanoux, Yuli V. Fuentes, Esteban García-Gallo, Gerard Moreno, Gustavo A. Ospina‐Tascón, Glenn Hernández, Edwin Silva, Ana María Álvarez‐Díaz, Manuel Jibaja, Magdalena Vera, Emilio Díaz, María Bodi, Jordi Solé‐Violán, Ricard Ferrer, Antonio Albaya-Moreno, Lorenzo Socías, Ángel Estella, Ana Loza-Vázquez, Ruth Jorge-García, Isabel Sancho, Ignacio Martín‐Loeches
Abstract
PURPOSE: Dexamethasone is the only drug that has consistently reduced mortality in patients with COVID-19, especially in patients needing oxygen or invasive mechanical ventilation. However, there is a growing concern about the relation of dexamethasone with the unprecedented rates of ICU-acquired respiratory tract infections (ICU-RTI) observed in patients with severe COVID-19. METHODS: This was a multicenter, prospective cohort study; conducted in ten countries in Latin America and Europe. We included patients older than 18 with confirmed SARS-CoV-2 requiring ICU admission. A multivariate logistic regression and propensity score matching (PSM) analysis was conducted to determine the relation between dexamethasone treatment and ICU-RTI. RESULTS: A total of 3777 patients were included. 2065 (54.7%) were treated with dexamethasone within the first 24 h of admission. After performing the PSM, patients treated with dexamethasone showed significantly higher proportions of VAP (282/1652 [17.1%] Vs. 218/1652 [13.2%], p = 0.014). Also, dexamethasone treatment was identified as an adjusted risk factor of ICU-RTI in the multivariate logistic regression model (OR 1.64; 95%CI: 1.37-1.97; p < 0.001). CONCLUSION: Patients treated with dexamethasone for severe COVID-19 had a higher risk of developing ICU-acquired respiratory tract infections after adjusting for days of invasive mechanical ventilation and ICU length of stay, suggesting a cautious use of this treatment.