Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases

Wiese, Andrew; Griffin, Marie R.; Schaffner, William; Stein, C. Michael; Greevy, Robert A.; Mitchel, Edward F.; Grijalva, Carlos G.

doi:10.7326/m17-1907

Cited by 82 publications

(54 citation statements)

References 36 publications

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“…Importantly, each of these studies consistently reported that patients using long-acting and high potency opioid formulations, opioids at high doses and opioids previously described as exhibiting immunosuppressive properties (i.e., morphine, codeine, fentanyl and methadone) had the highest risk for infection. The studies also noted a high risk for infections among patients recently initiating opioid use [18][19][20].…”

Section: Supporting Evidence From Recent Studies Among Humansmentioning

confidence: 95%

“…Opioid use was associated with an increased risk of multiple infection types across the three studies, demonstrating that the association cannot be fully explained by other opioid-related mechanisms which could contribute to infection (i.e., opioid-induced respiratory depression and microaspiration leading to pneumonia) [18][19][20]. Furthermore, each study applied strategies to account for potential protopathic bias (i.e., the possibility that individuals initiated opioid use to treat early symptoms of infection) and confounding by indication (i.e., individuals received opioids for an indication that is a risk factor for infection itself ) [18][19][20].…”

Section: Supporting Evidence From Recent Studies Among Humansmentioning

confidence: 97%

“…Similarly, in a study conducted among patients with rheumatoid arthritis enrolled in a State Medicaid program, periods of current opioid use were associated with a 38% increased risk of serious infections (including pneumonia, bacteremia, meningitis/encephalitis, septic arthritis/osteomyelitis, endocarditis, pyelonephritis and cellulitis) compared with periods of non-opioid use [19]. More recently, a nested case-control study, conducted in a population of subjects aged 5 years or older enrolled in a State Medicaid program, reported a 62% higher risk of laboratory-confirmed invasive pneumococcal disease among current users of opioids compared with past users [20]. Importantly, each of these studies consistently reported that patients using long-acting and high potency opioid formulations, opioids at high doses and opioids previously described as exhibiting immunosuppressive properties (i.e., morphine, codeine, fentanyl and methadone) had the highest risk for infection.…”

Section: Supporting Evidence From Recent Studies Among Humansmentioning

confidence: 99%

“…Furthermore, each study applied strategies to account for potential protopathic bias (i.e., the possibility that individuals initiated opioid use to treat early symptoms of infection) and confounding by indication (i.e., individuals received opioids for an indication that is a risk factor for infection itself ) [18][19][20]. In addition, in the study that examined the association between opioid use and the risk of laboratory-confirmed invasive pneumococcal disease, an extensive sensitivity analysis showed that residual confounding would be unlikely to explain the observed association [20]. The strength of the associations and the consistency of the findings in different populations and for different types of infection suggest that there is a clinically relevant association between opioid analgesic use and the risk of serious infections among humans, complementing the extensive evidence of opioid-induced immunosuppression from experimental animal studies.…”

Section: Supporting Evidence From Recent Studies Among Humansmentioning

confidence: 99%

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The Use of Prescribed Opioid Analgesics & the Risk of Serious Infections

Wiese

Grijalva

2018

Future Microbiol.

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Section: Supporting Evidence From Recent Studies Among Humansmentioning

confidence: 95%

Section: Supporting Evidence From Recent Studies Among Humansmentioning

confidence: 97%

Section: Supporting Evidence From Recent Studies Among Humansmentioning

confidence: 99%

Section: Supporting Evidence From Recent Studies Among Humansmentioning

confidence: 99%

See 2 more Smart Citations

The Use of Prescribed Opioid Analgesics & the Risk of Serious Infections

Wiese

Grijalva

2018

Future Microbiol.

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“…A growing concern is related to the use of these compounds in humans as, like in animals, opioid use is associated with an increased risk of bacterial infections like pneumococcal diseases [50]. A better understanding of how endogenous opioids as well as synthetic ones interact with bacterial cells may help in the identification of potential bacterial targets and the development of dual-therapy in high-risk patients.…”

Section: Effects Of Peptidic Hormones On Gram-negative Bacteriamentioning

confidence: 99%

Host Peptidic Hormones Affecting Bacterial Biofilm Formation and Virulence

Lesouhaitier¹,

Clamens²,

Rosay³

et al. 2018

J Innate Immun

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Bacterial biofilms constitute a critical problem in hospitals, especially in resuscitation units or for immunocompromised patients, since bacteria embedded in their own matrix are not only protected against antibiotics but also develop resistant variant strains. In the last decade, an original approach to prevent biofilm formation has consisted of studying the antibacterial potential of host communication molecules. Thus, some of these compounds have been identified for their ability to modify the biofilm formation of both Gram-negative and Gram-positive bacteria. In addition to their effect on biofilm production, a detailed study of the mechanism of action of these human hormones on bacterial physiology has allowed the identification of new bacterial pathways involved in biofilm formation. In this review, we focus on the impact of neuropeptidic hormones on bacteria, address some future therapeutic issues, and provide a new view of inter-kingdom communication.

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Infectious Diseases Mortality in the United States

Shuman

Malani

2018

JAMA

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Infectious disease is distinguished from most other fields of medicine by constant and rapid change. As microorganisms emerge, new treatment and prevention strategies also evolve. Although much progress has been made, infections remain a major and often preventable cause of death worldwide.In this issue of JAMA, el Bcheraoui and colleagues 1 report mortality trends for major infectious diseases in the United States, both nationally and at the county level, using data from the National Center for Health Statistics. In one of the first studies of its kind, the authors used deidentified death records to examine mortality trends for the most common causes of infectious diseases mortality, including lower respiratory infection, diarrheal disease, HIV/AIDS, hepatitis (excluding chronic hepatitis B and C), meningitis, and tuberculosis.The authors report that between 1980 and 2014, a total of 4 081 546 deaths due to infectious diseases were recorded in the United States. In 2014, a total of 113 650 (95% uncertainty interval [UI], 108 764-117 942) deaths or a rate of 34.10 (95% UI, 32.63-35.38) deaths per 100 000 persons were due to infectious diseases, compared with a total in 1980 of 72 220 (95% UI, 69 887-74 712) deaths or a rate of 41.95 (95% UI, 40.52-43.42) deaths per 100 000 persons, an overall decline of 18.73% (95% UI, 14.95%-23.33%).Lower respiratory infections remained the most common cause of infectious diseases mortality in 2014, accounting for 78.80% of all infectious diseases mortality with 26.87 (95% UI, 25.79-28.05) deaths per 100 000 persons, although mortality rates from lower respiratory infections have declined by 25.79% since 1980. It is likely that this decline is at least in part related to widespread use of pneumococcal vaccines among high-risk adults and children, yet substantial gaps in vaccine coverage persist (eg, in 2014, only 61.3% of adults 65 years and older received the recommended pneumococcal vaccines). 2 Among all of the infections evaluated by el Bcheraoui et al, 1 lower respiratory infection had the greatest variation among US counties, with some counties in the South and East demonstrating an increase in mortality due to lower respiratory infection. Although the precise reasons for these differences are not clear, socioeconomic factors contribute to risk of pneumonia. For example, persons with low income, homelessness, incarceration, and African American race/ethnicity have an increased risk of bacteremic pneumonia. 3 A recent study of Tennessee Medicaid recipients also suggested that prescription opioid use, particularly of potent, long-acting, high-dose opioids, was associated with increased risk of invasive pneumococcal disease. 4

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Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases

Abstract: National Institutes of Health.

Cited by 82 publications

References 36 publications

The Use of Prescribed Opioid Analgesics & the Risk of Serious Infections

The Use of Prescribed Opioid Analgesics & the Risk of Serious Infections

Host Peptidic Hormones Affecting Bacterial Biofilm Formation and Virulence

Infectious Diseases Mortality in the United States

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