Use of Glucocorticoids and Risk of Community-Acquired Staphylococcus aureus Bacteremia

• Published in: Mayo Clinic proceedings Vol. 91; no. 7; pp. 873 - 880
• Main Authors: Smit, Jesper, MD, Kaasch, Achim, MD, DMSc, Søgaard, Mette, DVM, PhD, Thomsen, Reimar W., MD, PhD, Nielsen, Henrik, MD, DMSc, Frøslev, Trine, MSc, Schønheyder, Henrik C., MD, DMSc
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-07-2016
• Subjects: Internal Medicine; OR; Anatomical Therapeutic Chemical; NSAID; CCI; community-acquired Staphylococcus aureus bacteremia; odds ratio; Charlson Comorbidity Index; ATC; SAB; AUPD; CA-SAB; Staphylococcus aureus bacteremia; Aarhus University Prescription Database; nonsteroidal anti-inflammatory drug
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2016.04.023

Abstract Objective To investigate whether the use of systemic glucocorticoids is a risk factor for community-acquired Staphylococcus aureus bacteremia (CA-SAB). Patients and Methods We used population-based medical registries in Northern Denmark to conduct a case-control study including all adults with first-time CA-SAB and matched population controls from January 1, 2000, through December 31, 2011. Glucocorticoid users were categorized as current users (new or long-term use), former users, and nonusers. Using conditional logistic regression, we computed odds ratios (ORs) of CA-SAB according to glucocorticoid exposure, overall and by 90-day prednisolone-equivalent cumulative dose. Results We identified 2638 patients with first-time CA-SAB and 26,379 matched population controls. Current glucocorticoid users experienced considerably increased risk of CA-SAB compared with nonusers (adjusted OR=2.48; 95% CI, 2.12-2.90). The adjusted OR was 2.73 (95% CI, 2.17-3.45) in new users, 2.31 (95% CI, 1.90-2.82) in long-term users, and much lower at 1.33 (95% CI, 0.98-1.81) in former users of glucocorticoids compared with nonusers. The risk of CA-SAB increased with higher 90-day cumulative doses. Compared with nonusers of glucocorticoids, the adjusted OR was 1.32 (95% CI, 1.01-1.72) for persons with a cumulative dose of 150 mg or less, 2.42 (95% CI, 1.76-3.33) for persons whose cumulative dose was greater than 500 to 1000 mg, and 6.25 (95% CI, 4.74-8.23) for persons with a cumulative dose greater than 1000 mg. Conclusion Glucocorticoid use was associated with a substantially increased risk of CA-SAB. The risk increased with higher cumulative dose, revealing a distinct dose-response relation.