Widely used as anti-inflammatory agents, systemic glucocorticoids can increase patients’ susceptibility to opportunistic infections with unintended consequences, according to authors of a review article. “The immunosuppressive effects of systemic glucocorticoids and increased susceptibility to infections are widely appreciated,” the writers note. “However, the dose-dependent model frequently used may not accurately predict the risk of infection in all patients treated with long-term glucocorticoids.”
Using a brief case of an older adult with acute hypoxic respiratory failure due to Pneumocystis jirovecii pneumonia (PJP) to illustrate the problem, the group writes: “The dose-dependent model frequently used may not accurately predict the risk of infection in all patients treated with long-term glucocorticoids. In this review, we examine the risks of opportunistic infections (OIs) in patients requiring glucocorticoid therapy by evaluating the influence of the glucocorticoid dose, duration, and potency, combined with biological and host clinical factors and concomitant immunosuppressive therapy. We propose strategies to prevent OIs, which involve screening, antimicrobial prophylaxis, and immunizations. While this review focuses on patients with autoimmune, inflammatory, or neoplastic diseases, the potential risks and preventative strategies are likely applicable to other populations. Clinicians should actively assess the benefit–harm ratios of systemic glucocorticoids and implement preventive efforts to decrease their associated infectious complications.”
