Superinfection risk in critically ill patients with severe COVID-19: a retrospective analysis of pulse steroid therapy with and without tocilizumab
Expert Review of Anti-Infective Therapy, cilt.24, sa.6, ss.639-646, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 24 Sayı: 6
- Basım Tarihi: 2026
- Doi Numarası: 10.1080/14787210.2026.2682316
- Dergi Adı: Expert Review of Anti-Infective Therapy
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Chemical Abstracts Core, CINAHL, EMBASE, MEDLINE, Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Sayfa Sayıları: ss.639-646
- Anahtar Kelimeler: Severe COVID-19, superinfection, pulse steroid therapy, tocilizumab, critical illness
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
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.