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Risk of systemic infections requiring hospitalization in children with atopic dermatitis: a Danish retrospective
C Droitcourt1,2,3,4, I Vittrup1,2, A Dupuy1,2,3,4
1Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Insights
Children diagnosed with atopic dermatitis (AD) face a higher risk of hospitalization for various infections. This study highlights increased rates of respiratory, urinary, musculoskeletal, and gastrointestinal infections in children with AD.
Area of Science:
- Pediatric Dermatology
- Infectious Diseases
- Epidemiology
Background:
- Infections can exacerbate atopic dermatitis (AD) symptoms.
- Understanding the link between AD and subsequent infections is crucial for patient management.
Purpose of the Study:
- To investigate the association between hospital-managed pediatric atopic dermatitis (AD) and the risk of extracutaneous infections requiring hospitalization.
- To assess if AD severity influences the risk of these infections.
Main Methods:
- A nationwide cohort study utilized Danish registries.
- Children under 18 with and without hospital-diagnosed AD were matched by age and sex.
- Infections leading to hospitalization were the primary outcomes, with AD severity based on treatment prescriptions.
Main Results:
- Children with AD showed increased hospitalization rates for lower respiratory tract infections (aHR 1.79), upper respiratory tract infections (aHR 1.59), urinary tract infections (aHR 1.34), musculoskeletal infections (aHR 1.33), and gastrointestinal infections (aHR 1.24).
- These associations remained consistent across different AD severity levels.
- The absolute risk difference for these infections per 10,000 person-years was generally low.
Conclusions:
- Hospital-managed atopic dermatitis in children is linked to an elevated risk of systemic infections requiring hospitalization.
- While the risk is increased, the absolute risk remains low, suggesting careful monitoring and management are key.
Background:
Infections can trigger worsening of atopic dermatitis (AD).
Objectives:
To examine whether hospital-managed paediatric AD is associated with increased risk of extracutaneous infections requiring hospitalization in childhood.
Methods:
A nationwide-based cohort study using Danish registries was done. Children aged < 18 years with a hospital diagnosis of AD and children without a hospital diagnosis of AD were sex- and age-matched at date of AD diagnosis. Study outcomes were extracutaneous infections that led to hospitalization. AD severity was defined according to prescriptions for treatments.
Results:
Of 19 415 children with AD [median follow-up 7·4 years; interquartile range (IQR) 3·3-13.3] and 194 150 without AD (median follow-up 7·7 years; IQR 3·6-13·5), 56% were boys and 50% were aged < 2 years. Children with AD had an increased rate of lower respiratory [LRTI; adjusted hazard ratio (aHR) 1·79, 95% confidence interval (CI) 1·65-1·94)], upper respiratory (URTI; aHR 1·59, 95% CI 1·34-1·88), urinary tract (UTI; aHR 1·34, 95% CI 1·16-1·54), musculoskeletal (MSSI; aHR 1·33, 95% CI 1·06-1·66) and gastrointestinal infections (GITIs; aHR 1·24, 95% CI 1·14-1·35) vs. children without AD. Associations did not clearly vary with AD severity. Absolute risk difference per 10 000 person-years was 26·4 (95% CI 23·0-29·8) for LRTIs, 3·1 (95% CI 1·6-4·7) for URTIs, 3·6 (95% CI 1·8-5·4) for UTIs, 0·9 (95% CI 0·2-2·0) for MSSIs and 8·7 (95% CI 5·7-11·7) for GITIs.
Conclusions:
Children with hospital-managed AD have an increased risk of systemic infections that lead to hospitalization; absolute risk is generally low.
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