The association between tocilizumab and the secondary bloodstream infection maybe nonsignificant in hospitalized patients with SARS-CoV-2 infection: A cohort study

Abstract

Background: Immunomodulatory agents, such as tocilizumab (TCZ), exert promising effects against SARS-CoV-2 infection. However, growing evidence indicates that using TCZ may carry higher risks of secondary bloodstream infection (sBSI). This study determined whether TCZ is associated with an increased risk of sBSI. Methods: We retrospectively collected the demographic and clinical data of hospitalized patients with SARS-CoV-2 infection from two Taiwanese hospitals. The time-to-incident sBSI in the TCZ users and nonusers was compared using the log-rank test. A multivariate Cox proportional hazards model was performed to identify independent risk factors for sBSI. Results: Between May 1 and August 31, 2021, among 453 patients enrolled, 12 (2.65 %) developed sBSI. These patients were in hospital for longer duration (44.2 31.4 vs. 17.6 14.3 days, p Z 0.014). Despite sBSI being more prevalent among the TCZ users (7.1 % vs. 1.6 %, p Z 0.005), KaplaneMeier survival analysis and multivariate Cox proportional hazards model both revealed no significant difference in risks of sBSI between the TCZ users and nonusers [adjusted HR (aHR) Z 1.32 (95 % confidence interval (CI) Z 0.29e6.05), p Z 0.724]. Female sex [aHR Z 7.00 (95 % CI Z 1.45e33.92), p Z 0.016], heavy drinking [aHR Z 5.39 (95 % CI Z 1.01e28.89), p Z 0.049], and mechanical ventilation [aHR Z 5.65 (95 % CI Z 1.67 e19.30), p Z 0.006] were independently associated with a higher sBSI risk. Conclusion: This real-world evidence indicates that in hospitalized patients with SARS-CoV-2 infection, TCZ does not significantly increase the risk of sBSI.