Effects of Inhaled Corticosteroids on Pneumonia Severity and Antimicrobial Resistance

Abstract

BACKGROUND Limited information is available regarding the impact of prior use of inhaled corticosteroids (ICS) in patients subsequently developing community-acquired pneumonia (CAP). We assessed the effects of prior ICS use on severity of illness and microbiology in CAP hospitalized patients. METHODS A retrospective cohort study of subjects with CAP (by the International Classification of Diseases, 9th Revision, Clinical Modification) was conducted over a 4-year period at 2 tertiary teaching hospitals. Subjects were considered to be ICS users if they received ICS prior to admission. Primary outcomes were severity of illness and microbiology at admission. RESULTS Data were abstracted on 664 subjects: 89 prior ICS users (13.4%) and 575 non-users (86.6%). Prior ICS users had higher severity of illness at admission: mean ± SD Pneumonia Severity Index 100.8 ± 31.4 vs 68.8 ± 33.4, P = .001, and CURB-65 (confusion, urea nitrogen, respiratory rate, blood pressure, > 65 years of age) score 1.56 ± 1.02 vs 1.19 ± 1.02, P = .002. Prior ICS use was independently associated with antimicrobial-resistant pathogens: 11.2% vs 5.9%, odds ratio 2.6, 95% CI 1.1– 6.1, P = .04. CONCLUSIONS Prior ICS use was associated with higher severity of illness at admission and higher incidence of antimicrobial-resistant pathogens in CAP hospitalized patients.

Inhaled corticosteroids and systemic inflammatory response in community‐acquired pneumonia: A prospective clinical study

“…It has been recently reported that ICS use in hospitalized patients with CAP is associated with higher severity risk scales at admission, mainly due to older age . In our study, we reproduced these observations.…”

“…It has been recently reported that ICS use in hospitalized patients with CAP is associated with higher severity risk scales at admission, mainly due to older age. 27 In our study, we reproduced these observations. Likewise, three observational studies in COPD patients hospitalized with CAP found an association between outpatient ICS therapy and decreased mortality at 30 and 90 days 11,12 and complications.…”

Community-Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease

“…Some studies have shown that COPD patients who were on inhaled corticosteroid have less mortality after developing CAP as compared with patients with COPD without prior inhaled corticosteroid use [42,43], but others have not shown any impact on outcome [27,38,44,45]. A small cross-sectional study from the USA showed that prior inhaled corticosteroid use was associated with higher severity of illness at admission and higher incidence of antimicrobial-resistant pathogens, particularly in those COPD patients hospitalized with CAP [46].…”

The risk and outcomes of pneumonia in patients on inhaled corticosteroids

“…In a recent study, Sibila et al [52] suggested that prior ICS use is associated with higher pneumonia severity at admission and an increased incidence of antimicrobial drug-resistant pathogens in patients hospitalized with CAP. In this study, most of the ICS users had a preexisting diagnosis of COPD (66%).…”