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Short-term steroid use in ICU linked to increased risk for C. neoformans
The short-term use of steroids may increase the risk for Cryptococcus neoformans infection, according to recent findings.
“Although long-term use of steroids is a known risk factor for cryptococcosis, the relationship between short-term steroid use and disease warrants further study,” the researchers wrote.
The researchers examined a cluster of six C. neoformans cases from a hospital in Arkansas during 2013. The patients were admitted for pneumonia with sepsis or respiratory failure (n = 3); severe anemia and acute renal failure (n = 1); nausea, vomiting and confusion (n = 1); and chest pain (n = 1). Four bloodstream infections and two respiratory infections were reported. Five of the patients died within 5 days of a positive C. neoformans diagnosis.
A retrospective cohort study was conducted to identify factors related to cryptococcosis. The researchers extracted data from the patients’ medical records, including steroid use and ICU length of stay. Steroid use was further assessed in 1,601 patients without cryptococcosis who were admitted to the ICU during the same duration.
The researchers said four of the five patients with C. neoformans were assigned short-term use of steroids before positive culture. Two patients received hydrocortisone (4 days and 11 days, respectively); one patient received methylprednisolone (1 day) followed by an oral prednisone taper (21 days), and one patient received methylprednisolone (5 days) and hydrocortisone (8 days). None of the patients received steroid treatment before hospital admission or shared any common exposures in the community.
The use of short-term steroids was significantly associated with cryptococcosis, according to the researchers. The rate of cryptococcosis was 40.1 cases per 10,000 person-days among patients receiving steroids (n = 121) vs. 2.1 cases per 10,000 person-days among patients not receiving steroids (RR = 19.1; 95% CI, 2.1-171.1). There were no confirmed indications that C. neoformans were transmitted to the patients through hospital staff. Furthermore, environmental swabs collected from the ICU rooms yielded negative results.
Additional studies at other hospitals should be conducted to determine the generalizability of the correlation between short-term steroid use and C. neoformans, the researchers wrote.
“We recommended heightened vigilance for cryptococcal infection among ICU patients, especially those receiving steroid treatment,” they wrote. “We also asked that physicians carefully assess the need for steroid use in patients admitted to the ICU and weigh the risk for possible cryptococcal infection against the benefits of steroid use in each patient’s case.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.