Superinfection risk in critically ill patients with severe COVID-19: a retrospective analysis of pulse steroid therapy with and without tocilizumab.

BACKGROUND

This study aimed to assess culture positivity rates and the microbiological profile of intensive care unit (ICU)-acquired superinfections in patients with severe COVID-19 pneumonia treated with pulse-dose methylprednisolone, with or without adjunctive tocilizumab.

RESEARCH DESIGN AND

METHODS

A total of 443 adult patients with confirmed COVID-19 pneumonia who received pulse-dose methylprednisolone were included. Patients were divided into two groups: those who received pulse steroids alone (PS group, n = 328) and those who received steroids plus tocilizumab (PS+TCZ group, n = 115). Superinfections were defined as new bacterial or fungal infections occurring ≥48 hours after ICU admission.

RESULTS

Culture positivity rates did not significantly differ between the PS and PS+TCZ groups in blood (48.6% vs. 57.4%; p = 0.219), tracheal aspirate (60.2% vs. 66.2%; p = 0.413), or urine (21.6% vs. 19.7%; p = 0.752) samples. The most frequently isolated organisms were coagulase-negative staphylococci (blood), Acinetobacter spp. (tracheal aspirates), and Candida albicans (urine). The PS+TCZ group had significantly longer ICU stays (18.5 ± 16.9 vs. 14.8 ± 13.1 days; p = 0.017) but a lower mortality rate (56.8% vs. 67.4%; p = 0.049) compared to the PS group.

CONCLUSION

The addition of tocilizumab to pulse-dose methylprednisolone did not increase the risk of ICU-acquired superinfection.