Steroid Use in Infections

Introduction to Steroid-Associated Infection Risks

The use of steroids can suppress the immune system through defects in lymphocyte signaling, increasing susceptibility to infections 1

In severe viral infections like COVID-19, low-dose and short-duration steroids can suppress the cytokine storm, potentially preventing progression to ARDS, with the American Thoracic Society recommending methylprednisolone (less than 1-2 mg/kg for 3-5 days) as adjunctive therapy in severe cases 2, 3, 4

The incidence of invasive aspergillosis in patients with severe alcoholic hepatitis treated with steroids was 16% during a three-month follow-up, according to the Infectious Diseases Society of America 1
Pneumocystis pneumonia has been reported with very high mortality rates, highlighting the need for caution when using steroids in patients at risk for opportunistic infections 1

Accurate screening for infections before starting steroid therapy is crucial, as recommended by the Centers for Disease Control and Prevention 1
Identifying the pathogen when possible, especially to exclude Nocardia or fungi, is important for guiding treatment, according to the European Society of Clinical Microbiology and Infectious Diseases 5
Continuing antibiotic therapy in patients with baseline infection who received prednisolone was associated with significantly reduced mortality (13% vs 52%), as noted by the American College of Gastroenterology 6, 1

Continuous monitoring for infections during and after steroid treatment is necessary, with a focus on respiratory infections, which account for 40% of all episodes, as advised by the American College of Chest Physicians 1
Bacterial infections represent about 90% of infectious episodes, underscoring the need for vigilant monitoring and appropriate antibiotic use, according to the Society for Healthcare Epidemiology of America 1

In immunocompromised patients, consideration of prophylactic antibiotics may be necessary, as suggested by the National Comprehensive Cancer Network 1
Elevated circulating bacterial DNA has predicted infection developing within seven days of prednisolone therapy, highlighting the potential benefit of early intervention, as reported by the European Association for the Study of the Liver 6