• Pauline Lamouche-Wilquin, Jérôme Souchard, Morgane Pere, Matthieu Raymond, Pierre Asfar, Cédric Darreau, Florian Reizine, Baptiste Hourmant, Gwenhaël Colin, Guillaume Rieul, Pierre Kergoat, Aurélien Frérou, Julien Lorber, Johann Auchabie, Béatrice La Combe, Philippe Seguin, Pierre-Yves Egreteau, Jean Morin, Yannick Fedun, Emmanuel Canet, LascarrouJean-BaptisteJBService de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 01, France. jeanbaptiste.lascarrou@chu-nantes.fr., and Agathe Delbove.
• Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 01, France.
• Crit Care. 2022 Aug 2; 26 (1): 233.

RationaleEarly corticosteroid treatment is used to treat COVID-19-related acute respiratory distress syndrome (ARDS). Infection is a well-documented adverse effect of corticosteroid therapy.ObjectivesTo determine whether early corticosteroid therapy to treat COVID-19 ARDS was associated with ventilator-associated pneumonia (VAP).MethodsWe 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.Measurements And Main ResultsOf 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).ConclusionsEarly 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.© 2022. The Author(s).

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