Risk of Coronavirus Disease 2019-Associated Pulmonary Aspergillosis Based on Corticosteroid Duration in Intensive Care Patients.

Autor: Shah M; Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.; Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.; Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA., Reveles K; Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.; Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA., Moote R; Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.; Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.; Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA., Hand E; Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.; Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA., Kellogg Iii D; Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, Joe R. and Terry Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA., Attridge RL; Feik School of Pharmacy, University of the Incarnate Word, San Antonio, Texas, USA.; The Craneware Group, Deerfield Beach, Florida, USA., Maselli DJ; Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, Joe R. and Terry Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA., Gutierrez GC; Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.; Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.; Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2023 Mar 03; Vol. 10 (3), pp. ofad062. Date of Electronic Publication: 2023 Mar 03 (Print Publication: 2023).
DOI: 10.1093/ofid/ofad062
Abstrakt: Background: Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a potential complication in critically ill COVID-19 patients. Corticosteroids are standard of care for hospitalized COVID-19 patients but carry an increased risk of secondary infections including CAPA. The objective of this study was to evaluate if duration of corticosteroid therapy ≤10 days versus >10 days affects the risk of developing CAPA.
Methods: This was a retrospective cohort study of adult patients with severe COVID-19 pneumonia requiring mechanical ventilation who received at least 3 days of corticosteroid treatment. Incidence of CAPA and secondary outcomes were compared using appropriate bivariable analyses. Steroid duration was evaluated as an independent predictor in a logistic regression model.
Results: A total of 278 patients were included (n = 169 for ≤10 days' steroid duration; n = 109 for >10 days). CAPA developed in 20 of 278 (7.2%) patients. Patients treated with >10 days of corticosteroid therapy had significantly higher incidence of CAPA (11.9% vs 4.1%; P = .0156), and steroid duration >10 days was independently associated with CAPA (odds ratio, 3.17 [95% confidence interval, 1.02-9.83]). Secondary outcomes including inpatient mortality (77.1% vs 43.2%; P < .0001), mechanical ventilation-free days at 28 days (0 vs 1.5; P < .0001), and secondary infections (44.9% vs 28.4% P = .0220) were worse in the >10 days cohort.
Conclusions: Corticosteroid treatment >10 days in critically ill COVID-19 patients is associated with an increased risk of CAPA. Patients may require corticosteroids for reasons beyond COVID-19 and clinicians should be cognizant of risk of CAPA with prolonged courses.
Competing Interests: Potential conflicts of interest. The authors have no conlicts of interest related to this work.
(© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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