People who use powerful drugs called systemic glucocorticoids are at higher risk for life-threatening staph blood infections, a new study finds.
Powerful immunosuppressive drugs
The findings are "a reminder for clinicians to weigh carefully the elevated risk against the potential beneficial effect of glucocorticoid therapy", said study lead author Dr Jesper Smit, of Aarhus University Hospital in Denmark.
"This is especially pertinent in patients who are already vulnerable to infection," he added.
Glucocorticoids – a form of steroids – are powerful immunosuppressive drugs used to treat a variety of medical conditions that involve inflammation.
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The drugs are "given by mouth or by injection, are anti-inflammatory, and can suppress the immune system", explained one US expert, Dr Gerald Bernstein.
"Usually, short-term use in otherwise healthy people does not cause a problem, but long term there could be consequences," said Bernstein, who coordinates the Friedman Diabetes Programme at Lenox Hill Hospital in New York City.
In the new study, Smit's team reviewed the medical records of nearly 30,000 people in Denmark. The study found that those who used systemic glucocorticoids were 2.5 times more likely than non-users to develop Staphylococcus aureus bacteria-associated blood infections outside of a hospital.
Infection risk rose along with the dose of the medicines given, the findings showed. Compared to non-users, those with a 90-day cumulative corticosteroid dose less than or equal to 150 milligrams (mg) had 2.4 times higher risk, but the risk was as high as 6.3 times greater for patients with a cumulative dose of more than 1,000 mg.
Among patients with connective tissue disease or chronic lung disease, the risk of staph blood infection was highest in people who used glucocorticoids long-term, the researchers found.
Among cancer patients, the risk was highest for new users of the drugs, according to the study.
Read: Experts aim to close cancer divide by 2025
The study authors said the increased risk of staph infections needs to be weighed against the potential benefits of the steroid drugs.
And Bernstein noted that glucocorticoids come with other dangers.
"For some diseases, the long-term use of large amounts of steroids will lead to a number of consequences, including osteoporosis and elevated blood glucose," he said.
A bunch of red flags
But the drugs can also be "lifesaving" in many cases, Bernstein said. "For certain diseases, people need to remain on a small dose chronically – and very often they do not have problems. In these situations the steroid is a miracle."
However, because glucocorticoids can suppress immune system function, it's not a big surprise that the risk for serious infections like staph might rise, Bernstein noted.
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"This study amplifies our need to have a bunch of red flags, so as to reduce the risk of this type of infection – and if the infection occurs, treat it as quickly as possible," he said. "For the patient and the clinician, [treatment] is a constant barrage of decision-making."
The study was published in Mayo Clinic Proceedings.
Glucocorticoids and the immune system
Immune system disorders
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