Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study

• DOI: 10.1186/s12879-021-06813-1
• Publication Date: 2021-11-01T16:02:45Z
• Authors: Ohoud Aljuhani; Khalid Al Sulaiman; Adel Alshabasy; Khalid Eljaaly; Abdulrahman I. Al...; Haytham Noureldeen; Mohammed Aboudeif; Bodoor Al Dosari; Amina Alkhalaf; Ghazwa B. Korayem; Muneera M. Aleissa; Hisham A. Badreldin; Shmeylan Al Harbi; Abdullah Alhammad; Ramesh Vishwakarma
• Keywords: Secondary infection; SARS-Cov-2; Research; Critical Illness; COVID-19; CRE; Infectious and parasitic diseases; RC109-216; Tocilizumab; Antibodies, Monoclonal, Humanized; COVID-19 Drug Treatment; 3. Good health; 03 medical and health sciences; Carbapenem-Resistant Enterobacteriaceae; 0302 clinical medicine; Drug Resistance, Multiple, Bacterial; Humans; Critically ill; Retrospective Studies

Abstract Background Tocilizumab is an IgG1 class recombinant humanized monoclonal antibody that directly inhibits the IL-6 receptor. Several randomized clinical trials have evaluated its safety and efficacy in patients with coronavirus disease 2019 (COVID-19), and these studies demonstrate conflicting results. Our study aimed to determine the association between tocilizumab treatment and microbial isolation and emergence of multidrug-resistant bacteria in critically ill patients with COVID-19.

Methods A multicenter retrospective cohort study was conducted at two tertiary government hospitals in Saudi Arabia. All critically ill patients admitted to intensive care units with a positive COVID-19 PCR test between March 1 and December 31, 2020, who met study criteria were included. Patients who received tocilizumab were compared to those who did not receive it.

Results A total of 738 patients who met our inclusion criteria were included in the analysis. Of these, 262 (35.5%) received tocilizumab, and 476 (64.5%) were included in the control group. Patients who received tocilizumab had higher odds for microbial isolation (OR 1.34; 95% CI 0.91–1.94, p = 0.13); however, the difference was not statistically significant. Development of resistant organisms (OR 1.00; 95% CI 0.51–1.98, p = 0.99) or detection of carbapenem-resistant Enterobacteriaceae (CRE) (OR 0.67; 95% CI 0.29–1.54, p = 0.34) was not statistically significant between the two groups.

Conclusions Tocilizumab use in critically ill patients with COVID-19 is not associated with higher microbial isolation, the emergence of resistant organisms, or the detection of CRE organisms.