IMR Press / FBS / Volume 14 / Issue 4 / DOI: 10.31083/j.fbs1404026
Open Access Review
Nosocomial Infections in COVID-19 Patients Treated with Immunomodulators: A Narrative Review
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1 Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA
2 Department of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, USA
3 Department of Critical Care, Bangalore Baptist Hospital, 560032 Bangalore, Karnataka, India
4 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA
*Correspondence:; (Amos Lal)
Academic Editor: Anna Aiello
Front. Biosci. (Schol Ed) 2022, 14(4), 26;
Submitted: 29 June 2022 | Revised: 5 September 2022 | Accepted: 7 September 2022 | Published: 26 September 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Nosocomial infections pose an imminent challenge to hospitalized Coronavirus disease-19 (COVID-19) patients due to complex interplay of dysregulated immune response combined with immunomodulator therapy. In the pre-pandemic era, immunomodulatory therapy has shown benefit in certain autoimmune conditions with untamed inflammatory response. Efforts to recapitulate these immunomodulatory effects in COVID-19 patients has gained impetus and were followed by NIH COVID-19 expert panel recommendations. The current NIH guideline recommends interleukin-6 inhibitors (tocilizumab and sarilumab) and Janus kinase inhibitors (baricitinib and tofacitinib). Several landmark research trials like COVAVTA, EMPACTA, REMDACTA, STOP-COVID and COV BARRIER have detailed the various effects associated with administration of immunomodulators. The historical evidence of increased infection among patients receiving immunomodulators for autoimmune conditions, raised concerns regarding administration of immunomodulators in COVID-19 patients. The aim of this review article is to provide a comprehensive update on the currently available literature surrounding this issue. We reviewed 40 studies out of which 37 investigated IL-6 inhibitors and 3 investigated JAK inhibitors. Among the studies reviewed, the reported rates of nosocomial infections among the COVID-19 patients treated with immunomodulators were similar to patients receiving standard of care for COVID-19. However, these studies were not powered to assess the side effect profile of these medications. Immunomodulators, by dampening the pyrogenic response and inflammatory markers may delay detection of infections among the patients. This underscores the importance of long-term surveillance which are necessary to discover the potential risks associated with these agents.

nosocomial infections
intensive care unit
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Fig. 1.
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