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.
Abbreviations and Acronyms:
ATC (Anatomical Therapeutic Chemical), AUPD (Aarhus University Prescription Database), CA-SAB (community-acquired Staphylococcus aureus bacteremia), CCI (Charlson Comorbidity Index), NSAID (nonsteroidal anti-inflammatory drug), OR (odds ratio), SAB (Staphylococcus aureus bacteremia)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: June 08, 2016
Footnotes
Grant Support: This work was supported by research grants from the Heinrich Kopp , Hertha Christensen , and North Denmark Health Sciences Research foundations . The sponsors did not have a role in any phase of the study conduct.
Identification
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© 2016 Mayo Foundation for Medical Education and Research
