TY - JOUR
T1 - The association between tocilizumab and the secondary bloodstream infection maybe nonsignificant in hospitalized patients with SARS-CoV-2 infection
T2 - A cohort study
AU - Lu, De En
AU - Ou, Tsong Yih
AU - Kang, Jyun Wei
AU - Ong, Jie Ywi
AU - Chen, I. Ju
AU - Lee, Chih Hsin
AU - Lee, Ming Chia
N1 - Publisher Copyright:
© 2023
PY - 2024/2
Y1 - 2024/2
N2 - Background: Immunomodulatory agents, such as tocilizumab (TCZ), exert promising effects against SARS-CoV-2 infection. However, growing evidence indicates that using TCZ may carry higher risks of secondary bloodstream infection (sBSI). This study determined whether TCZ is associated with an increased risk of sBSI. Methods: We retrospectively collected the demographic and clinical data of hospitalized patients with SARS-CoV-2 infection from two Taiwanese hospitals. The time-to-incident sBSI in the TCZ users and nonusers was compared using the log-rank test. A multivariate Cox proportional hazards model was performed to identify independent risk factors for sBSI. Results: Between May 1 and August 31, 2021, among 453 patients enrolled, 12 (2.65 %) developed sBSI. These patients were in hospital for longer duration (44.2 ± 31.4 vs. 17.6 ± 14.3 days, p = 0.014). Despite sBSI being more prevalent among the TCZ users (7.1 % vs. 1.6 %, p = 0.005), Kaplan–Meier survival analysis and multivariate Cox proportional hazards model both revealed no significant difference in risks of sBSI between the TCZ users and nonusers [adjusted HR (aHR) = 1.32 (95 % confidence interval (CI) = 0.29–6.05), p = 0.724]. Female sex [aHR = 7.00 (95 % CI = 1.45–33.92), p = 0.016], heavy drinking [aHR = 5.39 (95 % CI = 1.01–28.89), p = 0.049], and mechanical ventilation [aHR = 5.65 (95 % CI = 1.67–19.30), p = 0.006] were independently associated with a higher sBSI risk. Conclusion: This real-world evidence indicates that in hospitalized patients with SARS-CoV-2 infection, TCZ does not significantly increase the risk of sBSI.
AB - Background: Immunomodulatory agents, such as tocilizumab (TCZ), exert promising effects against SARS-CoV-2 infection. However, growing evidence indicates that using TCZ may carry higher risks of secondary bloodstream infection (sBSI). This study determined whether TCZ is associated with an increased risk of sBSI. Methods: We retrospectively collected the demographic and clinical data of hospitalized patients with SARS-CoV-2 infection from two Taiwanese hospitals. The time-to-incident sBSI in the TCZ users and nonusers was compared using the log-rank test. A multivariate Cox proportional hazards model was performed to identify independent risk factors for sBSI. Results: Between May 1 and August 31, 2021, among 453 patients enrolled, 12 (2.65 %) developed sBSI. These patients were in hospital for longer duration (44.2 ± 31.4 vs. 17.6 ± 14.3 days, p = 0.014). Despite sBSI being more prevalent among the TCZ users (7.1 % vs. 1.6 %, p = 0.005), Kaplan–Meier survival analysis and multivariate Cox proportional hazards model both revealed no significant difference in risks of sBSI between the TCZ users and nonusers [adjusted HR (aHR) = 1.32 (95 % confidence interval (CI) = 0.29–6.05), p = 0.724]. Female sex [aHR = 7.00 (95 % CI = 1.45–33.92), p = 0.016], heavy drinking [aHR = 5.39 (95 % CI = 1.01–28.89), p = 0.049], and mechanical ventilation [aHR = 5.65 (95 % CI = 1.67–19.30), p = 0.006] were independently associated with a higher sBSI risk. Conclusion: This real-world evidence indicates that in hospitalized patients with SARS-CoV-2 infection, TCZ does not significantly increase the risk of sBSI.
KW - SARS-CoV-2 infection
KW - Secondary bloodstream infections
KW - Tocilizumab
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U2 - 10.1016/j.jmii.2023.10.011
DO - 10.1016/j.jmii.2023.10.011
M3 - Article
C2 - 37951803
AN - SCOPUS:85176305277
SN - 1684-1182
VL - 57
SP - 38
EP - 47
JO - Journal of Microbiology, Immunology and Infection
JF - Journal of Microbiology, Immunology and Infection
IS - 1
ER -