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Risk of systemic infections in adults with atopic dermatitis: A nationwide cohort study
Catherine Droitcourt1, Ida Vittrup2, Sandrine Kerbrat3
1Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France; University of Rennes, Equipe d'Accueil 7449 REcherche en Pharmaco-Epidemiologie et REcours aux Soins "Pharmacoepidemiology and Health Services Research", Rennes, France.
Background:
Atopic dermatitis (AD) has been linked to systemic infections in adulthood, but large-scale studies are few, and potential associations are unclear.
Objective:
To examine whether adults with AD have increased risk of developing systemic infections leading to hospital-based management.
Methods:
Nationwide register-based cohort study including all Danish adults from 1995 through 2017. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by using Cox models.
Results:
A total of 10,602 adults with AD (median age, 29.8 y; interquartile range, 22.6-44.8) and 106,020 reference individuals were included. The overall incidence rate per 10,000 person-years of systemic infections was 180.6 (95% CI, 172.6-189.0) among adults with AD compared with 120.4 (95% CI, 118.3-122.5) among reference adults. The association between AD and systemic infections was observed for musculoskeletal (adjusted HR [aHR], 1.81; 95% CI, 1.42-2.31), heart (aHR, 1.75; 95% CI, 1.21-2.53), and upper (aHR, 1.42; 95% CI, 1.15-1.73) and lower respiratory tract infections (aHR, 1.21; 95% CI, 1.10-1.33). The risk of sepsis (aHR, 1.19; 95% CI, 1.01-1.44) and skin infections (aHR, 2.30; 95% CI, 2.01-2.62) was also increased.
Limitations:
The findings cannot be generalized to adults with milder AD seen outside the hospital system.
Conclusion:
We found an increased risk of systemic infections among adults with hospital managed AD.
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