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Systemic glucocorticoids increase risk for CA-S. aureus bacteremia
Patients receiving systemic glucocorticoids may be more than twice as likely to experience community-acquired Staphylococcus aureus bacteremia than those who did not receive the immunosuppressant, according to a recently published study.
“Glucocorticoids exert inhibitory effects on multiple immune responses mediated by neutrophilic leukocytes as well as suppressive effects on macrophage function, which may increase the risk of [S. aureus bacteremia (SAB)] in users,” Jesper Smit, MD, of the departments of clinical microbiology and infectious diseases at Aalborg University Hospital, and the department of clinical epidemiology at Aarhus University Hospital, Denmark, and colleagues wrote. “Nevertheless, few and conflicting data exist on the association between the use of glucocorticoids and the risk of SAB, and, to our knowledge, no previous study has investigated the use of glucocorticoids as a risk factor for SAB as the primary objective.”
Jesper Smit
Smit and colleagues examined the relationships between glucocorticoids and SAB using population data collected from Danish national medical registries before 2011. The researchers identified incident community-acquired SAB (CA-SAB) cases recorded as early as 1995, and compared these to 10 randomly selected population controls matched by age, sex and residence. Smit and colleagues characterized these patients by demographics, comorbidities, indication of glucocorticoid prescription and concurrent receipt of other medications, and then analyzed the pairings to detect any relevant associations.
There were 2,638 CA-SAB patients and 26,379 population controls included in the analysis. Of these, 379 CA-SAB patients and 827 controls currently used systemic glucocorticoids. The median age of participants was 69 years, and 61% were men. Patients with CA-SAB more frequently experienced comorbidity, and had increased use of oral antibiotics, immunomodulating agents and nonsteroidal anti-inflammatory drugs.
After adjustment, patients receiving systemic glucocorticoids were more likely to experience incident CA-SAB (adjusted OR = 2.48; 95% CI, 2.12-2.9). This pattern was more pronounced when limiting analysis to new users (aOR = 2,73; 95% CI, 2.17-3.45), but decreased among long-term users (aOR = 2.31; 95% CI, 1.9-2.82) or former users (aOR= 1.33; 95% CI, 0.98-1.81). While the risk of CA-SAB also increased with higher 90-day cumulative doses, and there was no difference in risk among patients of different ages or sex.
These findings would imply a distinct dose-response relation between glucocorticoids and CA-SAB, the researchers wrote, and raise new considerations for clinicians prescribing the immunosuppressant therapy.
“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,” Smit said in a press release. “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.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.