Use of Glucocorticoids Is Associated With Increased Risk of Serious Bacterial Blood Infection
The risk of life-threatening blood infections by Staphylococcus aureus bacteria is more than doubled in users of systemic glucocorticoids compared with non-users. The risk escalates with increasing dose, according to a new Danish population-based case-control study published in Mayo Clinic Proceedings.
S. aureus is a bacterium that normally lives harmlessly on the skin. Occasionally it causes infection, which can be fatal if the bacteria enter the bloodstream. Glucocorticoids are potent immunosuppressive drugs when given through the mouth or by injection and are used for treatment of many different medical conditions. Administered in this way, they have an inhibitory effect on immune responses, which depends on the dose, and this may be the explanation for the increase in the risk of this type of staphylococcal infection.
Researchers from the University Hospitals in Aalborg and Aarhus, Denmark and Cologne, Germany analyzed records of nearly 30,000 people using Danish medical registries over a 12-year period. The team investigated the risk of infection while taking into account duration of glucocorticoid use, 90-day cumulative dose, and specific groups of patients who are very frequently prescribed glucocorticoids.
Users of systemic glucocorticoids experienced a 2.5 times increased risk of S. aureus infection acquired outside of a hospital, as compared with non-users. The risk of infection rose gradually with increasing cumulative dose; compared with non-users, patients with a 90-day cumulative dose of less than or equal to 150 mg were 2.4 times more at risk, rising to as high as 6.3 times greater risk among those with a cumulative dose of more than 1000 mg.
Among patients with connective tissue disease or chronic pulmonary disease, the risk of S. aureus blood infection was most pronounced in long-term users of glucocorticoids, whereas the risk was highest for new users among cancer patients.
Investigators cautioned that the elevated risk of infection should be weighed against the potential beneficial effects. “Our study provides evidence that use of systemic glucocorticoids is associated with considerable risk of S. aureus blood infection, particularly among persons receiving high-dose therapy,” explained lead author Jesper Smit, MD, of the Department of Clinical Microbiology, Department of Infectious Diseases, Aalborg University Hospital, and Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. “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.”
The research group will continue to investigate risk and prognostic factors for S. aureus blood infections, including other types of medications.
Notes for editors
“Use of Glucocorticoids and Risk of Community-Acquired Staphylococcus aureus Bacteremia: A Population-Based Case-Control Study,” by Jesper Smit, MD; Achim Kaasch, MD, DMSc; Mette Søgaard, DVM, PhD; Reimar W. Thomsen, MD, PhD; Henrik Nielsen, MD, DMSc; Trine Frøslev, MSc; and Henrik C. Schønheyder, MD, DMSc (doi: 10.1016/j.mayocp.2016.04.023), Mayo Clinic Proceedings,Volume 91, Issue 7 (July 2016), published by Elsevier.
Full text of this study is available to credentialed journalists upon request. Contact Rachael Zaleski at +1 215 239 3658 or firstname.lastname@example.org to obtain copies. Journalists wishing to interview the authors should contact Jesper Smit, MD, Aalborg University Hospital, Department of Clinical Microbiology, at +45 2624 1332 or email@example.com.
About Mayo Clinic Proceedings
The flagship journal of Mayo Clinic and one of the premier peer-reviewed clinical journals in general medicine, Mayo Clinic Proceedings is among the most widely read and highly cited scientific publications for physicians, with a circulation of approximately 125,000. While the Journal is sponsored by Mayo Clinic, it welcomes submissions from authors worldwide, publishing articles that focus on clinical medicine and support the professional and educational needs of its readers. www.mayoclinicproceedings.org
About Mayo Clinic
Mayo Clinic is a nonprofit worldwide leader in medical care, research, and education for people from all walks of life. For more information visit www.mayoclinic.org/about and www.mayoclinic.org/news.
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com
+1 215 239 3658