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

Authors : Kadir CANOĞLU, Omer AYTEN

Pages : 1252-1258

Doi:10.32322/jhsm.1136479

View : 24 | Download : 14

Publication Date : 2022-09-25

Article Type : Research Paper

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 insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(40.2% vs. 21.2%; p=0.001);, secondary infection development insert ignore into journalissuearticles values(48.4% vs. 29.2%; p=0.003);, at least one drug resistant bacteria growth insert ignore into journalissuearticles values(46.7% vs. 27.4%; p=0.001);, extensively-drug resistant insert ignore into journalissuearticles values(XDR); microorganism growth insert ignore into journalissuearticles values(89.8% vs. 72.7%; p=0.033); were higher than the group that did not receive immunosuppressive treatment. VAP insert ignore into journalissuearticles values(53.3%; p=0.004);, secondary infection insert ignore into journalissuearticles values(73.3%; p=0.0002);, the growth of bacteria resistant to at least one drug insert ignore into journalissuearticles values(70%; p=0.0003); were highest in the corticosteroid plus tocilizumab group in the subgroup analysis. In addition, XDR insert ignore into journalissuearticles values(95.5% vs. 72.7%; p=0.032); and pan-drug resistant insert ignore into journalissuearticles values(PDR); microorganism growth insert ignore into journalissuearticles values(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 insert ignore into journalissuearticles values(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.
Keywords : Corticosteroids, COVID 19, IL 6 receptor, ventilator associated pneumonia