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Glucocorticoids may increase risk of serious blood infection

Current users of systemic glucocorticoids experienced 2.5 times higher odds of infection with Staphylococcus aureus bacteria than non-users, a Danish study published in Mayo Clinic Proceedings has found.

Glucocorticoids are potent immunosuppressive drugs used widely in treating acute and chronic conditions across almost all clinical specialties.

The researchers used medical registries in northern Denmark to analyse the records of 2639 people who had acquired S aureus bacteraemia in the community and had been hospitalised with the infection. These patients were then matched with 26 379 population controls. Glucocorticoid users were categorised as current users, former users, or non-users.

Current glucocorticoid users showed considerably higher odds of S aureus infection than non-users (adjusted odds ratio 2.48 (95% confidence interval 2.12 to 2.90)). The risk of infection with S aureus rose gradually with increasing cumulative dose. Patients with a 90 day cumulative dose of 150 mg or less had 2.4 times higher odds than non-users, and this rose to 6.3 times higher in those with a cumulative dose of more than 1000 mg.

Among patients with connective tissue disease or chronic pulmonary disease, the study found that the risk of S aureus blood infection was most pronounced in long term users of glucocorticoids. In cancer patients the risk was highest among new users of the drugs. The researchers found no substantial difference in the risk increase according to sex, age group, or comorbidity level.

Jesper Smit, lead author, from the department of clinical epidemiology at Aarhus University Hospital in Denmark, said, “These results may serve as a reminder for clinicians to weigh carefully the elevated risk against the potential beneficial effect of glucocorticoid therapy. This is especially pertinent in patients who are already vulnerable to infection.”


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