Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Evaluación del proyecto resistencia Zero como predictor de colonización por bacterias multirresistentes al ingreso en unidad de cuidados intensivos

Las enfermedades infecciosas permanecen como una de las principales causas de morbimortalidad en el planeta y la aparición de resistencias en las bacterias, virus o parásitos una consecuencia natural del uso de antibióticos en medicina y veterinaria, incluso cuando este es controlado 1. La introducción de nuevos antibacterianos (principalmente entre 1940 y 1980) supuso una revolución en el tratamiento de las enfermedades infecciosas, pero desde entonces son escasas las aportaciones de nuevos antibióticos eficaces y de administración sistémica para un selecto grupo de bacterias multirresistentes (BMR), por lo que probablemente nos enfrentemos a un futuro sin opciones terapéuticas para combatirlas 2-3. Aunque no existe una definición universalmente aceptada, las BMR son aquellas que al menos cumplen la condición de resistentes a dos o más grupos de antimicrobianos habitualmente empleados en las infecciones producidas por el microorganismo considerado y cuya resistencia tiene relevancia clínica 4. Las infecciones por gérmenes multirresistentes no responden con frecuencia al tratamiento antibiótico de inicio, prolongando la enfermedad y aumentando la mortalida