title: Increased use of antimicrobial agents and hospital admission for infections in patients with primary adrenal insufficiency: a cohort study.
abstract: BACKGROUND
  Previous studies have suggested that infections are an important cause of death in patients with Addison's disease, but epidemiological studies on the frequency of infections in this population are lacking.
  
  
  OBJECTIVE
  To assess and compare the incidence risk of infections in patients with primary adrenal insufficiency with controls.
  
  
  METHODS
  We conducted a cohort study, using data from the Dutch PHARMO record linkage system, that links patients' demographics and medication histories to hospital admissions.
  
  
  METHODS
  From a cohort of oral glucocorticoid users, 390 patients with primary adrenal insufficiency were identified by assessing concurrent use of glucocorticoids and mineralocorticoids using pharmacy dispensing records. A reference cohort (n=1933) with the same age and sex distribution was sampled from patients not using glucocorticoids.
  
  
  METHODS
  Incidence rates and incidence rate ratios (IRR) were calculated of infections, defined by use of antimicrobial agents, as well as hospital admissions for infection.
  
  
  RESULTS
  The incidence of infectious episodes, defined by usage of antimicrobial agents, among patients with primary adrenal insufficiency (incidence rate 59.2/100 person-years) was 1.5 times higher compared with controls, yielding a crude IRR OF 1.61 (95% CI 1.51-1.72). The IRR decreased slightly to 1.58 (95% CI 1.47-1.70) After adjustment for co-medication and co-morbidity also associated with infection risk. Also with respect to hospital admissions for infection, the incidence rates observed for patients with primary adrenal insufficiency was higher compared with controls (3.8/100 vs 0.8/100 person-years): crude IRR 5.02 (3.66-6.87) and adjusted IRR 4.34 (95% CI 3.04-6.22).
  
  
  CONCLUSIONS
  Patients with primary adrenal insufficiency had an increased use of antimicrobial agents and hospital admissions related to infection.
authors: Department of Internal Medicine and Infectious Diseases (Section Endocrinology), Utrecht University Medical Center, Utrecht, The Netherlands. l.c.c.j.smans@umcutrecht.nl
authors: Lisanne C C J
authors: LC
authors: Smans
authors: Patrick C
authors: PC
authors: Souverein
authors: Hubert G M
authors: HG
authors: Leufkens
authors: Andy I M
authors: AI
authors: Hoepelman
authors: Pierre M J
authors: PM
authors: Zelissen
mesh_terms: D000224:Addison Disease / Q000188:drug therapy* / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003141:Communicable Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents