Dexamethasone Increases Risk for Superinfections in Patients With Severe COVID-19

Dexamethasone was associated with a significantly increased risk for superinfections among patients with severe COVID-19 infection who required invasive mechanical ventilation (IMV), according to results of a study published in Journal of Infection.

To investigate the effects of dexamethasone among adult patients hospitalized with severe COVID-19 infection, investigators performed an observational, retrospective study at 7 hospitals in Norway between March 2020 and January 2021. Eligible patients included those with polymerase chain reaction-confirmed COVID-19 infection who were admitted to an ICU and required either IMV or extracorporeal membrane oxygenation.

A total of 155 patients were included in the analysis, of whom 72 and 83 were treated with vs without dexamethasone, respectively. Of all patients, the mean age was 62 (range, 26-84) years, 74% were men, the median time between hospitalization and ICU transfer was 2 (IQR, 1-4) days, and the median time from hospitalization to receipt of dexamethasone was 0 (IQR, 0-4) days. The most common comorbidities among patients who received dexamethasone were hypertension (50%), diabetes (28%), chronic lung disease (28%), and autoimmune disease (14%).

Of all patients, superinfections occurred in 43%. The investigators found that the risk for superinfection was significantly increased among patients treated with vs without dexamethasone (66% vs 32%; P <.0001). Other factors significantly associated with the occurrence of superinfections were autoimmune disease (P <.016) and longer ICU stay (P <.001).

After multiple regression analysis with adjustment for patient demographics, comorbidities, laboratory results on admission, and length of ICU stay, receipt of dexamethasone (odds ratio [OR], 3.7; 95% CI, 1.80-7.61; P <.001], preexisting autoimmune disease (OR, 3.82; 95% CI, 1.13-12.9; P =.031], and length of ICU stay (OR, 1.05; P <.001) remained associated with a significantly increased risk of developing a superinfection.

There were 8 invasive fungal infections, all of which occurred among patients who received dexamethasone. Although the rate of unadjusted 90-day survival was similar between patients who were vs were not diagnosed with a superinfection (64% vs 73%, P =.25), the rate was decreased among those who received dexamethasone (58% vs 78%, P =.007).

This study was limited by its observational and retrospective design, its small sample size, and the possibility that superinfection diagnoses were overestimated.

According to the investigators, “other anti-inflammatory and immunosuppressive agents are being tested [against] COVID-19, often in combination with dexamethasone.”

Reference

Søvik S, Barrat-Due A, Kåsine T, et al. Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation. J Infect. Published online May 21, 2022. doi: 10.1016/j.jinf.2022.05.015