Analysis of data from a large, multistate outbreak of fungal infections showed substantial morbidity and mortality. The infections were associated with injection of a contaminated glucocorticoid medication from a single compounding pharmacy. Rapid public health actions included prompt recall of the implicated product, notification of exposed persons, and early outreach to clinicians.

BACKGROUND-We investigated an outbreak of fungal infections of the central nervous system that occurred among patients who received epidural or paraspinal glucocorticoid injections of preservative-free methylprednisolone acetate prepared by a single compounding pharmacy.

Objective Animal and in vitro studies suggest that certain opioid analgesics impair crucial immune functions. We sought to determine if opioid use is associated with an increased risk of serious infections in patients with rheumatoid arthritis (RA). Methods We conducted a self-controlled case series analysis on a retrospective cohort of 13,796 patients with RA enrolled in Tennessee Medicaid (1995–2009). We performed within-person comparisons of the risk of hospitalizations for serious infections during periods of opioid use compared with non-use using conditional Poisson regression. Fixed confounders were accounted for by design, and time-varying confounders included age, the use of disease-modifying anti-rheumatic drugs, glucocorticoids and proton-pump inhibitors. Additional analyses examined new opioid use, use of opioids known to have immunosuppressive properties, long acting opioid use, and different opioid dosages. Sensitivity analyses accounted for potential protopathic bias and confounding by indication. Results Among 1,790 patients with RA who had at least one hospitalization for serious infection, the adjusted incidence rate of serious infection was higher during periods of current opioid use compared with non-use [incidence rate ratio (IRR): 1.39 (95% confidence interval (CI): 1.19–1.62)]. The incidence rate was also higher during periods of long-acting opioid use, immunosuppressive opioid use and new opioid use compared with non-use [IRR: 2.01 (95% CI: 1.52–2.66); IRR: 1.72 (95% CI: 1.33–2.23); IRR: 2.38 (95% CI: 1.65–3.42), respectively]. Results of sensitivity analyses were consistent with the main findings. Conclusions In within-person comparisons of patients with RA, opioid use was associated with an increased risk of hospitalizations for serious infection.

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National Institutes of Health.