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Incidence of secondary bacterial infections following utilization of tocilizumab for the treatment of COVID-19 – A matched retrospective cohort study


1 Department of Medicine, Nuvance Health, University of Vermont School of Medicine, Norwalk, Connecticut, USA
2 Department of Innovation and Research, Nuvance Health, Danbury, Connecticut, USA
3 Department of Pulmonary and Critical Care, Yale School of Medicine, University of Vermont School of Medicine, Nuvance Health, Norwalk, Connecticut, USA

Correspondence Address:
Joanna L Moore,
34 Maple Street, Norwalk, Connecticut 06850
USA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jgid.jgid_358_20

Context: Immunosuppressive agents are theorized to target the cytokine storm syndrome in COVID-19. However, the downstream effects regarding susceptibilities to secondary infection risk remains unknown. Aims: This study seeks to determine risk differences for secondary infections among COVID-19 patients who did and did not receive tocilizumab. Settings and Design: We conducted a matched retrospective cohort study from two large, acute care hospitals in Western Connecticut from March 1, to May 31, 2020. Subjects and Methods: We collected variables using manual medical record abstraction. The primary exposure variable was any dose of tocilizumab. The primary outcome was any healthcare-associated bacterial or fungal infection as defined by the National Healthcare Safety Network. Statistical Analysis Used: We performed a Kaplan–Meier analysis to assess the crude difference in cumulative probability of healthcare-associated infection (HAI) across exposure groups. We also performed a multivariable Cox regression analysis to determine the hazard ratio for HAI by exposure group while controlling for potential confounders. Results: The Kaplan–Meier analysis demonstrated no difference in the cumulative probability of HAI across groups. The adjusted hazard of HAI for patients given tocilizumab was 0.85 times that of patients not given tocilizumab (95% confidence interval = 0.29, 2.52, P = 0.780) after controlling for relevant confounders. Conclusions: Tocilizumab did not increase the incidence of secondary infection among COVID-19 patients. Larger, randomized trials should evaluate infection as a secondary outcome to validate this finding.


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    -  Moore JL
    -  Stroever SJ
    -  Rondain PE
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008