Impact of Inflammatory Response Modifiers on the Incidence of Hospital-Acquired Infections in Patients with COVID-19

Meira, Fernanda; Moreno-García, Estela; Linares, Laura; Macaya, Irene; Tomé, Adria; Hernández-Meneses, Marta; Albiach, Laia; Morata, Laura; Letona, Laura; Bodro, Marta; Cózar-Llistó, Alberto; Cardozo, Celia; Chumbita, Mariana; Pitart, Cristina; Ambrosioni, Juan; Rico, Verónica; Agüero, Daiana; Puerta-Alcalde, Pedro; Garcia-Pouton, Nicole; Marco, Francesc; Garcia-Vidal, Carolina; Soriano, Alex; Martínez, José Antonio

INTRODUCTION: The study aim was to assess the influence of inflammatory response modifiers, including anti-interleukin-6 (IL-6) biologics and corticosteroids, on the incidence of hospital-acquired infections in patients with coronavirus disease 2019 (COVID-19). METHODS: Case–control study performed at a university hospital from February 26 to May 26, 2020. Cases were defined as patients with COVID-19 who developed hospital-acquired infections. For each case, two controls were selected among patients without infections. Cases and controls were matched obeying three criteria in a hierarchical sequence: length of hospital stay up until the first infection; comorbidity; and need for Intensive care unit (ICU) admission. Conditional logistic regression analysis was used to estimate the association of exposures with being a case. RESULTS: A total of 71 cases and 142 controls were included. Independent predictors for acquiring a hospital infection were chronic liver disease [odds ratio (OR) 16.56, 95% CI 1.87–146.5, p = 0.012], morbid obesity (OR 6.11, 95% CI 1.06–35.4, p = 0.043), current or past smoking (OR 4.15, 95% CI 1.45–11.88, p = 0.008), exposure to hydroxychloroquine (OR 0.2, 95% CI 0.041–1, p = 0.053), and invasive mechanical ventilation (OR 61.5, 95% CI 11.08–341, p ≤ 0.0001). CONCLUSIONS: Inflammatory response modifiers had no influence on acquisition of nosocomial infections in admitted patients with COVID-19. Hospital-acquired infections primarily occurred in the critically ill and invasive mechanical ventilation was the main exposure conferring risk. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40121-021-00477-9.