Infections associated with steroid use

State University of New York School of Medicine, Stony Brook, New York, USA.
Infectious Disease Clinics of North America (Impact Factor: 2.73). 07/2001; 15(2):423-32, viii. DOI: 10.1016/S0891-5520(05)70154-9
Source: PubMed


Patients receiving chronic steroids have an increased susceptibility to many different types of infections. The risk of infection is related to the dose of steroid and the duration of therapy. Although pyogenic bacteria are the most common pathogens, chronic steroid use increases the risk of infection with intracellular pathogens such as Listeria, many fungi, the herpes viruses, and certain parasites. Clinicians should consider both common and unusual opportunistic infections in patients receiving chronic steroids.

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    • "Post-operative abscesses and local infections were more common in the steroid maintenance group. This predisposition to infections, especially pyogenic infections as seen in our maintenance group, is related to the dose and duration of steroid therapy and was described by Klein in 2001 [20]. A larger proportion of recipients in the maintenance group performed activities of daily living (ADL) with no assistance compared to the induction only group, and could be said to have a better functional status. "
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    ABSTRACT: The appropriateness of steroid maintenance in pancreas transplantation is unproven. The current literature is insufficient due to small numbers, short follow-up and sparse data. Data from the UNOS database on adults ≥18 years old, who received pancreas and kidney-pancreas transplants between January 1996 and March 2014 were analyzed (n = 27,077). Two groups were evaluated: (a) Steroids Induction only (n = 4391) and (b) Steroid maintenance (n = 22,686). One-, 3-, 5-, 10-, and 15-year unadjusted patient and graft survival rates were compared. A Cox proportional hazards model was used to determine what patient factors were associated with these outcomes. There were differences in patient survival at 1 and 3 years and in graft survival at 3 and 5 years. There was a higher rate of infectious complications in the maintenance group, but after controlling for several recipient factors, whether a patient received steroid maintenance or not, was not significantly associated with the risk of death or graft failure. The use of maintenance steroids is significantly associated with an increased risk of infectious complications, but no difference in patient death or graft failure after controlling for multiple recipient factors. There is also no benefit with the use of steroid maintenance after pancreas transplantation. Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.
    Full-text · Article · Aug 2015 · Pancreatology
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    • "The use of steroid also affects the development of infection. Dexamethasone-based regimens decrease in cell-mediated immunity and could increase the risk of infection by encapsulated bacterial organisms, viruses, or fungi [13]. Hyperglycemia induced by steroid could play a role of increased susceptibility of infection [14]. "
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    ABSTRACT: The association between hyperglycemia and infections during induction chemotherapy has been reported in a number of hematologic disorders. This retrospective study evaluated the incidence of hyperglycemia during induction therapy in 155 patients with newly diagnosed multiple myeloma (MM) and its effect on serious infections during the first 60 days of induction. A total of 20 (12.9%) patients developed overt hyperglycemia (≥200 mg/dL) during induction therapy. Serious infections occurred in 28 (18.1%) of 155 patients and infection-related mortality within 2 months after treatment was 0.6% (1 patient). In a univariate analysis, overt hyperglycemia, poor performance status (≥2), International Staging System III, lymphopenia (<500/μL), and elevated serum creatinine (≥2 mg/dL) were found to be associated with serious infections. In multivariate analysis, only overt hyperglycemia (HR 7.846, 95% CI 2.512–24.503, P < 0.001 ) and poor performance status (HR 5.801, 95% CI 1.974–17.050, P = 0.001 ) remained significant. In conclusion, this study demonstrated an association between hyperglycemia and serious infections during induction therapy in patients with MM.
    Full-text · Article · Apr 2014
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    • "Use of prednisone for greater than 3 weeks or of a dose greater than 16 mg/day is associated with opportunistic infections [88]. Patients receiving >50 mg/day had a fourfold increased risk [89], related to inhibition of T cell mediated immune responses [89], as CD4 + and CD8 + T cells apoptose upon glucocorticoid exposure [90]. When glucocorticoids are required, use of the lowest possible dose to achieve a clinical response for the shortest duration of time will reduce infection risk [88]. "
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    ABSTRACT: Infectious agents are considered to be crucial environmental factor in the etiopathogenesis of systemic lupus erythematosus (SLE). Infections may serve as initial trigger to the development of autoimmunity and carry an overall greater risk of morbidity and mortality than the general population. Initial presentation of SLE can mimic infections, and in turn infections can mimic disease flares in established SLE. Infections due to predisposition by commonly used immunosuppressive therapies are a significant cause of morbidity and mortality. In this review, viral, bacterial, fungal, and parasitic infections that contribute to the etiology of SLE, potentially mimic or precipitate flares, create diagnostic dilemmas, complicate treatment, or protect against disease, are discussed. Infection risks of current immunosuppressive therapies used in the treatment of SLE are outlined. Strategies to prevent infection, including vaccines, prophylactic antibiotic therapies, toll-like receptor antagonism, and antioxidant treatment that may decrease disease burden and improve quality of life in lupus patients will be discussed.
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