Early corticosteroid treatment is used to treat COVID-19-related acute respiratory distress syndrome (ARDS). Infection is a well-documented adverse effect of corticosteroid therapy. To determine whether early corticosteroid therapy to treat COVID-19 ARDS was associated with ventilator-associated pneumonia (VAP). We retrospectively included adults with COVID-19-ARDS requiring invasive mechanical ventilation (MV) for ≥ 48 h at any of 15 intensive care units in 2020. We divided the patients into two groups based on whether they did or did not receive corticosteroids within 24 h. The primary outcome was VAP incidence, with death and extubation as competing events. Secondary outcomes were day 90-mortality, MV duration, other organ dysfunctions, and VAP characteristics. Of 670 patients (mean age, 65 years), 369 did and 301 did not receive early corticosteroids. The cumulative VAP incidence was higher with early corticosteroids (adjusted hazard ratio [aHR] 1.29; 95% confidence interval [95% CI] 1.05–1.58; P = 0.016). Antibiotic resistance of VAP bacteria was not different between the two groups (odds ratio 0.94, 95% CI 0.58–1.53; P = 0.81). 90-day mortality was 30.9% with and 24.3% without early corticosteroids, a nonsignificant difference after adjustment on age, SOFA score, and VAP occurrence (aHR 1.15; 95% CI 0.83–1.60; P = 0.411). VAP was associated with higher 90-day mortality (aHR 1.86; 95% CI 1.33–2.61; P = 0.0003). Early corticosteroid treatment was associated with VAP in patients with COVID-19-ARDS. Although VAP was associated with higher 90-day mortality, early corticosteroid treatment was not. Longitudinal randomized controlled trials of early corticosteroids in COVID-19-ARDS requiring MV are warranted.

中文翻译：

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COVID-19 相关 ARDS 中的早期类固醇和呼吸机相关性肺炎

早期皮质类固醇治疗用于治疗 COVID-19 相关的急性呼吸窘迫综合征 (ARDS)。感染是皮质类固醇治疗的一个有据可查的不良反应。确定用于治疗 COVID-19 ARDS 的早期皮质类固醇治疗是否与呼吸机相关性肺炎 (VAP) 相关。我们回顾性纳入了 2020 年在 15 个重症监护病房中的任何一个需要有创机械通气 (MV) ≥ 48 小时的 COVID-19-ARDS 成人。我们根据患者在 24 年内是否接受皮质类固醇治疗分为两组。 H。主要结局是 VAP 发生率，死亡和拔管是相互竞争的事件。次要结局是 90 天死亡率、MV 持续时间、其他器官功能障碍和 VAP 特征。在 670 名患者中（平均年龄 65 岁），369 人接受了早期皮质类固醇治疗，301 人未接受早期皮质类固醇治疗。早期皮质类固醇的累积 VAP 发生率较高（调整后的风险比 [aHR] 1.29；95% 置信区间 [95% CI] 1.05-1.58；P = 0.016）。两组间 VAP 细菌的抗生素耐药性无差异（优势比 0.94，95% CI 0.58-1.53​​；P = 0.81）。90 天死亡率分别为 30.9% 和 24.3% 早期皮质类固醇，调整年龄、SOFA 评分和 VAP 发生后无显着差异（aHR 1.15；95% CI 0.83-1.60；P = 0.411）。VAP 与较高的 90 天死亡率相关（aHR 1.86；95% CI 1.33–2.61；P = 0.0003）。早期皮质类固醇治疗与 COVID-19-ARDS 患者的 VAP 相关。尽管 VAP 与较高的 90 天死亡率相关，但早期皮质类固醇治疗与此无关。