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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Anti-Bacterial Agents, Bacterial Load, Cardiopulmonary Resuscitation, Cross Infection, Desoxycorticosterone, Dexamethasone, Dogs, Dose-Response Relationship, Drug, Drug Interactions, Drug Therapy, Combination, Glucocorticoids, Microbial Sensitivity Tests, Mineralocorticoids, Oxacillin, Pneumonia, Staphylococcal, Severity of Illness Index, Shock, Septic, Survival Analysis.
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Do beneficial effects of stress-dose corticosteroid therapy in canines depend on the severity of staphylococcal pneumonia? Context: The effects of stress-dose corticosteroid therapy were studied in a canine staphylococcal pneumonia model of septic shock. Immediately following intrabronchial bacterial challenge, purpose-bred beagles were treated with stress doses of desoxycorticosterone (DOC), a mineralocorticoid agonist, and dexamethasone (DEX), a glucocorticoid agonist, or with placebo for 96 h. Oxacillin (30 mg/kg every 8 h) was started 4 h after infection onset. Bacterial dose was titrated to achieve 80-90 % lethality (n = 20) using an adaptive design; additional animals (n = 18) were investigated using the highest bacterial dose. Initial analysis of all animals (n = 38) demonstrated that the effects of DOC + DEX were significantly altered by bacterial dose (p = 0.04). The treatment effects of DOC + DEX were different in animals administered high or relatively lower bacterial doses in terms of survival (p = 0.05), shock reversal (p = 0.02), interleukin-6 levels (p = 0.02), and temperature (p = 0.01). DOC + DEX significantly improved the above parameters (p ≤ 0.03 for all) and lung injury scores (p = 0.02) after high-dose bacterial challenges, but not after lower challenges (p = not significant for all). Oxacillin trough levels were below the minimum inhibitory concentration of the infecting organism, and DOC + DEX increased the frequency of persistent staphylococcal bacteremia (odds ratio 3.09; 95 % confidence interval 1.05-9.11; p = 0.04).
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Stress-dose corticosteroids were only beneficial in cases of sepsis with high risk for death and even short courses may interfere with host mechanisms of bacterial clearance. Final Decision: yes