{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:46:39Z","timestamp":1791477999309,"version":"4.3.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T00:00:00Z","timestamp":1700179200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T00:00:00Z","timestamp":1700179200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["ACF-2021-16-001"],"award-info":[{"award-number":["ACF-2021-16-001"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["CL-2019-16-001"],"award-info":[{"award-number":["CL-2019-16-001"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009947","name":"Merck Sharp and Dohme","doi-asserted-by":"publisher","award":["60408"],"award-info":[{"award-number":["60408"]}],"id":[{"id":"10.13039\/100009947","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Immunosuppressive therapies have become a cornerstone of the management of severe COVID-19. The impact of these therapies on secondary infections and antimicrobial prescribing remains unclear. We sought to assess antimicrobial use and the incidence of bacterial and fungal infections in patients with severe COVID-19, and to explore their associations with receipt of immunosuppressive therapies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Our retrospective cohort study included 715 hospitalised, adult patients with severe COVID-19 admitted to St George\u2019s Hospital, London, UK, during the first UK pandemic wave (1<jats:sup>st<\/jats:sup> March\u201310<jats:sup>th<\/jats:sup> June 2020). Co-infections (occurring within 48\u00a0h of admission) and secondary infections (\u2265\u200948\u00a0h) were defined as a positive microbiological culture with supporting clinical, radiological or laboratory data to suggest true infection. Cox regression models with time-dependent covariates were used to explore the association between immunosuppressant use and secondary infection.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Microbiologically confirmed co-infection occurred in 4.2% (<jats:italic>n<\/jats:italic>\u2009=\u200930) and secondary infection in 9.3% (<jats:italic>n<\/jats:italic>\u2009=\u200966) of the cohort (<jats:italic>n<\/jats:italic>\u2009=\u2009715) and were associated with in-hospital mortality (48% vs 35%, OR 1.8, 95%CI 1.1\u20132.7, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). Respiratory (<jats:italic>n<\/jats:italic>\u2009=\u200941, 39%) and bloodstream infections (<jats:italic>n<\/jats:italic>\u2009=\u200938, 36%) predominated, with primarily Gram-negative pathogens. 606 (84.7%) patients received an antimicrobial, amounting to 742\u00a0days of therapy per 1000 patient-days (DOTs). In multivariable models, receipt of high-dose steroids (\u2265\u200930\u00a0mg prednisolone or equivalent) or tocilizumab was significantly associated with increased antimicrobial consumption (+\u20095.5 DOTs, 95%CI 3.4\u20137.7\u00a0days) but not secondary infection (HR 0.56, 95%CI 0.26\u20131.18).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Bacterial and fungal infections in severe COVID-19 were uncommon. Receipt of steroids or tocilizumab was independently associated with antimicrobial consumption despite its lack of association with secondary infection. These findings should galvanise efforts to promote antimicrobial stewardship in patients with COVID-19.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-023-08697-9","type":"journal-article","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T16:03:45Z","timestamp":1700237025000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The impact of immunosuppressive therapy on secondary infections and antimicrobial use in COVID-19 inpatients: a retrospective cohort study"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9094-6558","authenticated-orcid":false,"given":"Peter","family":"Crook","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3037-8314","authenticated-orcid":false,"given":"Clare","family":"Logan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1560-7465","authenticated-orcid":false,"given":"Andrea","family":"Mazzella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3193-4888","authenticated-orcid":false,"given":"Rachel M.","family":"Wake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5371-2314","authenticated-orcid":false,"given":"Martina","family":"Cusinato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0558-0772","authenticated-orcid":false,"given":"Ting","family":"Yau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee-Ean","family":"Ong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0263-0888","authenticated-orcid":false,"given":"Timothy","family":"Planche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Basarab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2676-838X","authenticated-orcid":false,"given":"Tihana","family":"Bicanic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,17]]},"reference":[{"key":"8697_CR1","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1111\/irv.12398","volume":"10","author":"EY Klein","year":"2016","unstructured":"Klein EY, et al. 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Ethical approval was granted without the need for informed consent from participants as the study was using routinely collected clinical data. This research was carried out in accordance with the principles of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"TB has received speaker fees, advisory board fees and research fellowship funding from Gilead Sciences, advisory board fees from Mundipharma and research grants from Pfizer and MSD. CL has received conference sponsorship from Gilead Sciences UK. TY has received sponsorship and\/or honorarium from Gilead Sciences, Pfizer, Astella Pharma, Renascience Pharma and Tillotts Pharma. All other authors have no interests to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"808"}}