{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:42:54Z","timestamp":1787654574179,"version":"build-2736575974"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Corticosteroids improve survival in hospitalized COVID-19 patients needing supplemental oxygen. However, concern exists about increased risk of secondary infections. This study investigated the impact of early corticosteroids use on these infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 registry were analyzed for adult patients, stratified by early corticosteroid use (within 48\u202fh of admission). The primary outcome was documented secondary infections, including bacteremia, bacterial pneumonia, empyema, meningitis\/encephalitis, septic shock, and ventilator-associated pneumonia. Univariate and multivariable logistic regression models were used to assess the association between early corticosteroids and these outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 17,092 eligible patients, with 13.5% developed at least one secondary bacterial infection during hospitalization. Patients receiving early corticosteroids were older (median 63\u202fyears) compared to those who did not (median 60\u202fyears), with a similar gender distribution (42.5% vs. 44.2% female). Unadjusted analysis revealed a higher risk for any secondary infection (OR 1.93, 95% CI 1.76\u20132.12). This association persisted for specific infections including bacteremia (OR 2.0, 95% CI 1.58\u20132.54), bacterial pneumonia (OR 1.5, 95% CI 1.27\u20131.77), and septic shock (OR 1.67, 95% CI 1.44\u20131.93). However, the effect on meningitis\/encephalitis (OR 0.62, 95% CI 0.24\u20131.57) and ventilator-associated pneumonia (VAP; OR 1.08, 95% CI 0.75\u20131.57) was non-significant. Adjusted analysis maintained significance for any secondary infection (OR 1.15, 95% CI 1.02\u20131.29), bacteremia (OR 1.43, 95% CI 1.09\u20131.88), and infections with unknown sources (OR 1.63, 95% CI 1.31\u20132.02). Notably, the association weakened and became non-significant for bacterial pneumonia (OR 0.98, 95% CI 0.81\u20131.20) and septic shock (OR 0.94, 95% CI 0.79\u20131.11), while it became significant for meningitis\/encephalitis (OR 0.26, 95% CI 0.08\u20130.82). VAP remained non-significant (OR 0.87, 95% CI 0.56\u20131.34).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Early use of corticosteroids increased overall secondary infection risk in hospitalized COVID-19 patients, but the impact varied. Risk of bacteremia was notably increased, while the association with bacterial pneumonia and septic shock weakened after adjustment becoming non-significant and surprisingly reduced meningitis\/encephalitis risk was noted suggesting the complexity of corticosteroid effects. Further research is needed to understand how corticosteroids influence specific secondary infections, and thereby optimize the treatment strategies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1466346","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T11:53:31Z","timestamp":1739534011000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The association between early corticosteroid use and the risk of secondary infections in hospitalized patients with COVID-19: a double-edged sword. Results from the international SCCM discovery viral infection and respiratory illness universal study (VIRUS) COVID-19 registry"],"prefix":"10.3389","volume":"12","author":[{"given":"Vikas","family":"Bansal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitesh K.","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amos","family":"Lal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anwar","family":"Khedr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysun","family":"Tekin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas B.","family":"Jama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noura","family":"Attallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esraa","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisham Ahmed","family":"Mushtaq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjan Jahani","family":"Kondori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thoyaja","family":"Koritala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna Lee","family":"Armaignac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy B.","family":"Christie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umamaheswara","family":"Raju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Khanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Cartin-Ceba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devang K.","family":"Sanghavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"La Nou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Boman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishakha","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan J.","family":"Walkey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Pablo","family":"Domecq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Kashyap","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Anjum","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1016\/j.mayocp.2020.02.003","article-title":"Guide to understanding the 2019 novel coronavirus","volume":"95","author":"Shah","year":"2020","journal-title":"Mayo Clin Proc"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1097\/CCM.0000000000004879","article-title":"Outcomes of patients with coronavirus disease 2019 receiving organ support therapies: the international viral infection and respiratory illness universal study registry","volume":"49","author":"Domecq","year":"2021","journal-title":"Crit Care Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e40","DOI":"10.1097\/CCM.0000000000005232","article-title":"Characterization and outcomes of hospitalized children with coronavirus disease 2019: a report from a multicenter, viral infection and respiratory illness universal study (coronavirus disease 2019) registry","volume":"50","author":"Bhalala","year":"2022","journal-title":"Crit Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1111\/ijd.16134","article-title":"Cutaneous manifestations of hospitalized COVID-19 patients in the VIRUS COVID-19 registry","volume":"61","author":"Deo","year":"2022","journal-title":"Int J Dermatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1097\/PCC.0000000000002760","article-title":"Coronavirus disease 2019-associated PICU admissions: a report from the society of critical care medicine discovery network viral infection and respiratory illness universal study registry","volume":"22","author":"Tripathi","year":"2021","journal-title":"Pediatr Crit Care Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e 0514","DOI":"10.1097\/CCE.0000000000000514","article-title":"Risk factors for critical coronavirus disease 2019 and mortality in hospitalized young adults: an analysis of the Society of Critical Care Medicine discovery viral infection and respiratory illness universal study (VIRUS) coronavirus disease 2019 registry","volume":"3","author":"Tripathi","year":"2021","journal-title":"Crit Care Explor"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"780872","DOI":"10.3389\/fendo.2022.780872","article-title":"Association of obesity with COVID-19 severity and mortality: an updated systemic review, meta-analysis, and meta-regression","volume":"13","author":"Singh","year":"2022","journal-title":"Front Endocrinol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1016\/j.mayocp.2020.05.010","article-title":"A collaborative multidisciplinary approach to the management of coronavirus disease 2019 in the hospital setting","volume":"95","author":"Razonable","year":"2020","journal-title":"Mayo Clin Proc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e8192","DOI":"10.7759\/cureus.8192","article-title":"A review of neurological complications of COVID-19","volume":"12","author":"Sheraton","year":"2020","journal-title":"Cureus"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"287","DOI":"10.4103\/Ijam.Ijam_94_20","article-title":"Pregnancy during COVID-19 pandemic - maternal and neonatal outcomes: a concise review","volume":"6","author":"Khan","year":"2020","journal-title":"Int J Acad Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e10051","DOI":"10.7759\/cureus.10051","article-title":"Impact of COVID-19 on the mental health of children and adolescents","volume":"12","author":"Shah","year":"2020","journal-title":"Cureus"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"113360","DOI":"10.1016\/j.psychres.2020.113360","article-title":"Psychological effects of the COVID 19 pandemic on healthcare workers globally: a systematic review","volume":"292","author":"Sheraton","year":"2020","journal-title":"Psychiatry Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"58","DOI":"10.18433\/jpps31002","article-title":"Current drugs with potential for treatment of COVID-19: a literature review","volume":"23","author":"Md Insiat Islam","year":"2020","journal-title":"J Pharm Pharm Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"259","DOI":"10.18433\/jpps31346","article-title":"Anti-inflammatory properties of drugs used to control COVID-19 and their effects on the renin-angiotensin system and angiotensin-converting Enzyme-2","volume":"23","author":"Gilzad-Kohan","year":"2020","journal-title":"J Pharm Pharm Sci"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"606429","DOI":"10.3389\/fmed.2020.606429","article-title":"Mortality benefit of Remdesivir in COVID-19: a systematic review and Meta-analysis","volume":"7","author":"Bansal","year":"2020","journal-title":"Front Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"624924","DOI":"10.3389\/fmed.2021.624924","article-title":"Mortality benefit of convalescent plasma in COVID-19: a systematic review and Meta-analysis","volume":"8","author":"Bansal","year":"2021","journal-title":"Front Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"703661","DOI":"10.3389\/fmed.2021.703661","article-title":"Mortality and severity in COVID-19 patients on ACEIs and ARBs-A systematic review, Meta-analysis, and Meta-regression analysis","volume":"8","author":"Singh","year":"2021","journal-title":"Front Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"p e0566","DOI":"10.1097\/CCE.0000000000000566","article-title":"Variation in use of repurposed medications among patients with coronavirus disease 2019. From the Society of Critical Care Medicine discovery viral infection and respiratory illness universal study: coronavirus disease 2019 registry Investigator Group","volume":"3","author":"Garcia","year":"2021","journal-title":"Criti Care Explorat"},{"key":"ref19","year":""},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e0113","DOI":"10.1097\/CCE.0000000000000113","article-title":"The viral infection and respiratory illness universal study (VIRUS): an international registry of coronavirus 2019-related critical illness","volume":"2","author":"Walkey","year":"2020","journal-title":"Crit Care Explor"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e1038","DOI":"10.1097\/CCM.0000000000004572","article-title":"Guiding principles for the conduct of observational critical care research for coronavirus disease 2019 pandemics and beyond: the Society of Critical Care Medicine discovery viral infection and respiratory illness universal study registry","volume":"48","author":"Walkey","year":"2020","journal-title":"Crit Care Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e27921","DOI":"10.2196\/27921","article-title":"Lessons from a rapid project management exercise in the time of pandemic: methodology for a global covid-19 virus registry database","volume":"11","author":"Turek","year":"2022","journal-title":"JMIR Res Protoc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.3201\/eid1408.071313","article-title":"Deaths from bacterial pneumonia during 1918-19 influenza pandemic","volume":"14","author":"Brundage","year":"2008","journal-title":"Emerg Infect Dis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s41479-021-00083-w","article-title":"The role of co-infections and secondary infections in patients with COVID-19","volume":"13","author":"Feldman","year":"2021","journal-title":"Pneumonia"},{"key":"ref25","first-page":"1071","article-title":"Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1) - United States, May-August 2009","volume":"58","year":"2009","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e60845","DOI":"10.1371\/journal.pone.0060845","article-title":"Clinical characteristics and outcomes in hospitalized patients with respiratory viral co-infection during the 2009 H1N1 influenza pandemic","volume":"8","author":"Echenique","year":"2013","journal-title":"PLoS One"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s10096-020-04142-w","article-title":"Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome","volume":"40","author":"Bardi","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.1007\/s00134-020-06219-8","article-title":"Bacterial and fungal superinfections in critically ill patients with COVID-19","volume":"46","author":"Bassetti","year":"2020","journal-title":"Intensive Care Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s13054-021-03460-5","article-title":"Ventilator-associated pneumonia in critically ill patients with COVID-19","volume":"25","author":"Maes","year":"2021","journal-title":"Crit Care"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1164\/rccm.202106-1354OC","article-title":"Bacterial superinfection pneumonia in patients mechanically ventilated for COVID-19 pneumonia","volume":"204","author":"Pickens","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1007\/s00134-020-06323-9","article-title":"Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study","volume":"47","author":"Rouze","year":"2021","journal-title":"Intensive Care Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1017\/ice.2021.362","article-title":"The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: a summary of data reported to the National Healthcare Safety Network","volume":"43","author":"Weiner-Lastinger","year":"2022","journal-title":"Infect Control Hosp Epidemiol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1186\/s13054-022-04108-8","article-title":"Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set","volume":"26","author":"Conway Morris","year":"2022","journal-title":"Crit Care"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"ofab201","DOI":"10.1093\/ofid\/ofab201","article-title":"Characterization of bacterial and fungal infections in hospitalized patients with coronavirus disease 2019 and factors associated with health care-associated infections","volume":"8","author":"Kubin","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1177\/08850666211032175","article-title":"The impact of corticosteroids on secondary infection and mortality in critically ill COVID-19 patients","volume":"36","author":"Ritter","year":"2021","journal-title":"J Intensive Care Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1002\/phar.2637","article-title":"Corticosteroid use in ARDS and its application to evolving therapeutics for coronavirus disease 2019 (COVID-19): a systematic review","volume":"42","author":"Landolf","year":"2022","journal-title":"Pharmacotherapy"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"114","DOI":"10.4103\/0970-2113.80324","article-title":"Corticosteroids and ARDS: a review of treatment and prevention evidence","volume":"28","author":"Khilnani","year":"2011","journal-title":"Lung India"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1093\/cid\/cix801","article-title":"Corticosteroids in patients hospitalized with community-acquired pneumonia: systematic review and individual patient data meta-analysis","volume":"66","author":"Briel","year":"2018","journal-title":"Clin Infect Dis"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1001\/jama.2020.16747","article-title":"Corticosteroids in COVID-19 ARDS: evidence and hope during the pandemic","volume":"324","author":"Prescott","year":"2020","journal-title":"JAMA"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s13613-020-0642-4","article-title":"Impact of corticosteroid treatment on clinical outcomes of influenza-associated ARDS: a nationwide multicenter study","volume":"10","author":"Tsai","year":"2020","journal-title":"Ann Intensive Care"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/s13054-019-2395-8","article-title":"The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis","volume":"23","author":"Ni","year":"2019","journal-title":"Crit Care"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1001\/jama.2020.17023","article-title":"Association between Administration of Systemic Corticosteroids and Mortality among Critically ill Patients with COVID-19: a Meta-analysis","volume":"324","author":"Sterne","year":"2020","journal-title":"JAMA"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1056\/NEJMoa2021436","article-title":"Dexamethasone in hospitalized patients with COVID-19","volume":"384","author":"Horby","year":"2021","journal-title":"N Engl J Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1097\/01.ccm.0000726472.05866.e3","article-title":"146: controversial role of corticosteroids on mortality in COVID-19: systematic review and Meta-analysis","volume":"49","author":"Mehra","year":"2021","journal-title":"Crit Care Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1001\/jamainternmed.2018.5849","article-title":"Association of Corticosteroid Treatment with Outcomes in adult patients with Sepsis: a systematic review and Meta-analysis","volume":"179","author":"Fang","year":"2019","journal-title":"JAMA Intern Med"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1056\/NEJMoa051693","article-title":"Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome","volume":"354","author":"Steinberg","year":"2006","journal-title":"N Engl J Med"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1001\/jama.2020.17022","article-title":"Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19: the REMAP-CAP COVID-19 corticosteroid domain randomized clinical trial","volume":"324","author":"Angus","year":"2020","journal-title":"JAMA"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1001\/jama.2020.16761","article-title":"Effect of hydrocortisone on 21-day mortality or respiratory support among critically ill patients with COVID-19: a randomized clinical trial","volume":"324","author":"Dequin","year":"2020","journal-title":"JAMA"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1016\/j.arbres.2022.07.017","article-title":"Pre-hospital aspirin use and patient outcomes in COVID-19: results from the international viral infection and respiratory illness universal study (VIRUS)","volume":"58","author":"Lal","year":"2022","journal-title":"Arch Bronconeumol"},{"key":"ref51","year":"2020"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.1016\/j.ijsu.2014.07.014","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration","volume":"12","author":"Vandenbroucke","year":"2014","journal-title":"Int J Surg"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/j.cmi.2020.07.016","article-title":"Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis","volume":"26","author":"Langford","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"e114","DOI":"10.1017\/ash.2022.253","article-title":"Coronavirus disease 2019 (COVID-19): secondary bacterial infections and the impact on antimicrobial resistance during the COVID-19 pandemic","volume":"2","author":"Markovskaya","year":"2022","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.jinf.2022.05.015","article-title":"Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation","volume":"85","author":"Sovik","year":"2022","journal-title":"J Infect"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1097\/IPC.0000000000001188","article-title":"Longer steroid treatment increases secondary bloodstream infection risk among patients with COVID-19 requiring intensive care","volume":"30","author":"Dupper","year":"2022","journal-title":"Infect Dis Clin Pract"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"e000766","DOI":"10.1136\/bmjresp-2020-000766","article-title":"Impact of corticosteroids in hospitalised COVID-19 patients","volume":"8","author":"Ho","year":"2021","journal-title":"BMJ Open Respir Res"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"368504231207209","DOI":"10.1177\/00368504231207209","article-title":"Secondary infections in critically ill patients with COVID-19 receiving steroid therapy","volume":"106","author":"Pearce","year":"2023","journal-title":"Sci Prog"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.12998\/wjcc.v9.i5.1058","article-title":"Clinical features of SARS-CoV-2-associated encephalitis and meningitis amid COVID-19 pandemic","volume":"9","author":"Huo","year":"2021","journal-title":"World J Clin Cases"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"3603","DOI":"10.1007\/s00415-023-11715-0","article-title":"Steroids for the treatment of viral encephalitis: a systematic literature review and meta-analysis","volume":"270","author":"Hodzic","year":"2023","journal-title":"J Neurol"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1001\/jama.2020.17021","article-title":"Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX randomized clinical trial","volume":"324","author":"Tomazini","year":"2020","journal-title":"JAMA"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1466346\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T11:53:34Z","timestamp":1739534014000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1466346\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,14]]},"references-count":61,"alternative-id":["10.3389\/fmed.2025.1466346"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1466346","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,14]]},"article-number":"1466346"}}