ABSTRACT
Background. COVID-19 can cause serious illness requiring multimodal treatment of the viral infection and its associated complications, including the potential for secondary infections. Studies have suggested an increased risk of fungal infections, including candidemia following severe COVID-19 though understanding of risk factors and clinical outcomes remains unclear. Methods. A multi-center, case-control study of patients with severe COVID-19 was conducted to evaluate risk factors and clinical outcomes in patients who developed candidemia between August 2020 to August 2021. Risk factors associated with candidemia and mortality were characterized using multivariate analyses. Results. A total of 275 patients were enrolled in the study, including 91 patients with severe COVID-19 and subsequent candidemia and 184 patients with severe COVID-19 without candidemia. Most patients received antibiotics prior to candidemia episode (93%), while approximately one-quarter of all patients received biologic for COVID-19. In-hospital mortality was significantly higher in the case group compared to the control group (68% vs 40%, P < 0.01). Multivariable logistic regression revealed that the use of central lines, biologic and paralytic therapy were independent risk factors for candidemia. The presence of candidemia, older age, central line use, and intensive care unit admission were significantly associated with mortality. Demographics and Baseline Characteristics of Study Patients with SARS-CoV-2 Positive With or Without Candidemia Hospitalization Details and Outcomes Conclusion. Clinicians should be aware of the possibility of development of candidemia in hospitalized older patients with severe COVID-19 and should closely monitor those patients at risk. Risk factors for developing candidemia in the setting of COVID-19 are largely consistent with classic risk factors previously identified.
ABSTRACT
Background: Severe Covid-19 is associated with elevated inflammatory markers, consistent with cytokine release syndrome (CRS). Tocilizumab is an IL-6 inhibitor, effective in treating CRS secondary to CAR-T cell therapy. The efficacy of tocilizumab in treating Covid-19 is unknown. Methods: This was a retrospective cohort study conducted at two hospitals in northern New Jersey. All patients treated with tocilizumab for confirmed or suspected Covid-19 between the dates of 3/10/20 and 4/9/20 at the study sites were included. The primary endpoint was clinical improvement on day 7 after treatment as assessed by respiratory status. Univariate analysis compared data between those who improved and those who did not. Results: Forty five severe and critically ill patients treated with tocilizumab for Covid-19 were evaluated. Eleven (24%), 22 (49%) and 12 (27%) patients improved, had no change and worsened by day 7 after treatment, respectively. Lower WBC and LDH at the time of drug administration as well as shorter time from supplemental oxygen initiation to dose were significantly associated with clinical improvement in the univariate analysis. Conclusion: Tocilizumab administration was associated with a low rate of clinical improvement within 7 days in this cohort of severe and critically ill patients with Covid-19.