This population-based cohort study between 2000 and 2012 from the UK’s Health Improvement Network database compared diagnoses between 275,000 adults who had been prescribed corticosteroids and 626,000 who had not been prescribed corticosteroids. The query was whether corticosteroid recipients had a higher risk of infection compared with those not receiving steroids.
The study demonstrated that there was a higher rate of infection among glucocorticosteroid recipients versus non-recipients for cutaneous cellulitis (HR = 2.21), herpes zoster (HR = 2.37), bloodstream infection (HR = 3.96), candidiasis (HR = 4.93), and lower respiratory tract infections (HR = 5.42). Patients with COPD or asthma had the highest rate of lower respiratory tract infections and patients with cancer had a disproportionately higher rate of candidiasis and bloodstream infections (likely from a higher frequency of indwelling vascular access devices).
Steroids have always been a double-edged sword with many benefits but also many risks. The increased rate of infection is one of the many known risks of chronic steroid use which also includes steroid myopathy, steroid psychosis, cataracts, osteoporosis, skin atrophy, and diabetes.