The Risk Factors for Nosocomial Infection in Chinese Patients with Active Rheumatoid Arthritis in Shanghai

Synopsis Corticosteroids are frequently used to treat rheumatic diseases. Their use comes with a number of well-established risks including osteoporosis, avascular necrosis, glaucoma, and diabetes. The risk of infection is of utmost concern and is well-documented, although randomized controlled trials (RCTs) of short term and lower dose steroids have generally shown little or no increased risk. Observational studies from the “real world”, however, have consistently shown dose-dependent increases in risk for serious infections as well as certain opportunistic infections (e.g. herpes zoster, tuberculosis, and PJP). In patients who begin chronic steroid therapy, vaccination and screening strategies should be utilized in an attempt to mitigate this risk.

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Infection Risk and Safety of Corticosteroid Use

Youssef

Novosad

Winthrop

2016

Rheumatic Disease Clinics of North America

361

299

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Association of baseline steroid use with long-term rates of infection and sepsis in the REGARDS cohort

et al. 2017

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BackgroundPrior studies associate steroid use with infection risk but were limited to select populations and short follow-up periods. The association of steroid use with long-term risk of community-acquired infections is unknown. We sought to determine the association of steroid risk with long-term risks of community- acquired infections and sepsis.MethodsWe used data on 30,239 adults aged ≥ 45 years old from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The primary exposure was oral or injectable steroid use, determined from medication inventory obtained at baseline in-home visit. The primary outcome was time to first infection event during 2003–2012, determined through adjudicated review of hospital records. We determined associations between baseline steroid use and first infection hospitalization events using Cox proportional hazards models, adjusting for demographics, health behaviors, chronic medical conditions, and medication adherence. Among the first infection hospitalization events, we also determined the association between baseline steroid use and sepsis.ResultsSteroid use was reported in 2.24% (n = 677) of the study population. There were 2593 incident infection events during the 10-year follow-up period. Infection incidence rates were higher for steroid than non-steroid users (37.99 vs. 13.79 per 1000 person-years). Steroid use was independently associated with increased risk of infection (adjusted HR 2.10, 95% CI: 1.73–2.56). Among first-infection events, steroid use was associated with increased odds of sepsis (adjusted OR 2.11, 95% CI: 1.33–3.36). The associations persisted in propensity matched analyses as well as models stratified by propensity score and medication adherence.ConclusionsIn this population-based cohort study, baseline steroid use was associated with increased long-term risks of community-acquired infections and sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1767-1) contains supplementary material, which is available to authorized users.

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The Risk Factors for Nosocomial Infection in Chinese Patients with Active Rheumatoid Arthritis in Shanghai

Cited by 2 publications

References 15 publications

Infection Risk and Safety of Corticosteroid Use

Infection Risk and Safety of Corticosteroid Use

Association of baseline steroid use with long-term rates of infection and sepsis in the REGARDS cohort

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