Khatri Akshay, Malhotra Prashant, Izard Stephanie, Kim Angela, Oppenheim Michael, Gautam-Goyal Pranisha, Chen Thomas, Doan Thien-Ly, Berlinrut Ilan, Niknam Negin, Flannery Sarah, Hirschwerk David, Epstein Marcia, Farber Bruce
Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York, USA.
Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.
Open Forum Infect Dis. 2021 Jun 30;8(7):ofab339. doi: 10.1093/ofid/ofab339. eCollection 2021 Jul.
Immunosuppressive therapies proposed for Coronavirus disease 2019 (COVID-19) management may predispose to secondary infections. We evaluated the association of immunosuppressive therapies with bloodstream-infections (BSIs) in hospitalized COVID-19 patients.
This was an institutional review board-approved retrospective, multicenter, cohort study of adults hospitalized with COVID-19 over a 5-month period. We obtained clinical, microbiologic and laboratory data from electronic medical records. Propensity-score-matching helped create balanced exposure groups. Demographic characteristics were compared across outcome groups (BSI/no BSI) using two-sample t-test and Chi-Square test for continuous and categorical variables respectively, while immunosuppressive therapy use was compared using McNemar's test. Conditional logistic regression helped assess the association between immunosuppressive therapies and BSIs.
13,007 patients were originally included, with propensity-score-matching producing a sample of 6,520 patients. 3.74% and 3.97% were diagnosed with clinically significant BSIs in the original and propensity-score-matched populations respectively. COVID-19 patients with BSIs had significantly longer hospitalizations, higher intensive care unit admission and mortality rates compared to those without BSIs. On univariable analysis, combinations of corticosteroids/anakinra [odds-ratio (OR) 2.00, 95% confidence intervals (C.I.) 1.05-3.80, P value.0342] and corticosteroids/tocilizumab [OR 2.13, 95% C.I. 1.16-3.94, value .0155] were significantly associated with BSIs. On multivariable analysis (adjusting for confounders), combination corticosteroids/tocilizumab were significantly associated with any BSI [OR 1.97, 95% C.I. 1.04-3.73, value.0386] and with bacterial BSIs [OR 2.13, 95% C.I. 1.12-4.05, p-value 0.0217].
Combination immunosuppressive therapies were significantly associated with BSI occurrence in COVID-19 patients; their use warrants increased BSI surveillance. Further studies are needed to establish their causative role.
为管理2019冠状病毒病（COVID-19）而提出的免疫抑制疗法可能会增加继发感染的风险。我们评估了免疫抑制疗法与住院COVID-19患者血流感染（BSIs）之间的关联。
这是一项经机构审查委员会批准的回顾性、多中心队列研究，研究对象为5个月内住院的COVID-19成年患者。我们从电子病历中获取了临床、微生物学和实验室数据。倾向得分匹配有助于创建平衡的暴露组。分别使用两样本t检验和卡方检验对连续变量和分类变量在不同结局组（BSI/无BSI）之间比较人口统计学特征，而使用McNemar检验比较免疫抑制疗法的使用情况。条件逻辑回归有助于评估免疫抑制疗法与BSIs之间的关联。
最初纳入13,007例患者，倾向得分匹配后得到6,520例患者的样本。在原始人群和倾向得分匹配人群中，分别有3.74%和3.97%被诊断为具有临床意义的BSIs。与无BSIs的COVID-19患者相比，发生BSIs的患者住院时间显著更长，重症监护病房入住率和死亡率更高。在单变量分析中，皮质类固醇/阿那白滞素联合使用[比值比（OR）2.00，95%置信区间（C.I.）1.05 - 3.80，P值.0342]以及皮质类固醇/托珠单抗联合使用[OR 2.13，95% C.I. 1.16 - 3.94，P值.0155]与BSIs显著相关。在多变量分析（校正混杂因素）中，皮质类固醇/托珠单抗联合使用与任何BSI[OR 1.97，95% C.I. 1.04 - 3.73，P值.0386]以及细菌BSIs[OR 2.13，95% C.I. 1.12 - 4.05，P值0.0217]显著相关。
联合免疫抑制疗法与COVID-19患者BSI的发生显著相关；使用这些疗法时需要加强对BSI的监测。需要进一步研究以确定它们的因果关系。
