Reyes, Luis FelipeRodriguez, AlejandroBastidas, AlirioParra-Tanoux, DanielaFuentes, Yuli VGarcía-Gallo, EstebanMoreno, GerardOspina-Tascon, GustavoHernandez, GlennSilva, EdwinDíaz, Ana MariaJibaja, ManuelVera, MagdalenaDíaz, EmilioBodí, MaríaSolé-Violán, JordiFerrer, RicardAlbaya-Moreno, AntonioSocias, LorenzoEstella, ÁngelLoza-Vazquez, AnaJorge-García, RuthSancho, IsabelMartin-Loeches, IgnacioLIVEN-COVID-19 Investigators and COVID-19 SEMICYUC Study Group2023-05-032023-05-032022-02-23http://hdl.handle.net/10668/22297Dexamethasone is the only drug that has consistently reduced mortality in patients with COVID-19, especially in patients needing oxygen or invasive mechanical ventilation. However, there is a growing concern about the relation of dexamethasone with the unprecedented rates of ICU-acquired respiratory tract infections (ICU-RTI) observed in patients with severe COVID-19. This was a multicenter, prospective cohort study; conducted in ten countries in Latin America and Europe. We included patients older than 18 with confirmed SARS-CoV-2 requiring ICU admission. A multivariate logistic regression and propensity score matching (PSM) analysis was conducted to determine the relation between dexamethasone treatment and ICU-RTI. A total of 3777 patients were included. 2065 (54.7%) were treated with dexamethasone within the first 24 h of admission. After performing the PSM, patients treated with dexamethasone showed significantly higher proportions of VAP (282/1652 [17.1%] Vs. 218/1652 [13.2%], p = 0.014). Also, dexamethasone treatment was identified as an adjusted risk factor of ICU-RTI in the multivariate logistic regression model (OR 1.64; 95%CI: 1.37-1.97; p Patients treated with dexamethasone for severe COVID-19 had a higher risk of developing ICU-acquired respiratory tract infections after adjusting for days of invasive mechanical ventilation and ICU length of stay, suggesting a cautious use of this treatment.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/COVID-19Critical careDexamethasonePneumoniaSevere COVID-19DexamethasoneHumansIntensive Care UnitsProspective StudiesRisk FactorsSARS-CoV-2COVID-19 Drug Treatmentresearch article35217370open access10.1016/j.jcrc.2022.1540141557-8615PMC8863516https://doi.org/10.1016/j.jcrc.2022.154014https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8863516/pdf