Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel.
Department of Family Medicine, Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel.
Pharmacoepidemiol Drug Saf. 2023 Jul;32(7):718-725. doi: 10.1002/pds.5602. Epub 2023 Feb 20.
Chronic and short-term treatment with oral corticosteroids is associated with an increased risk of infection. However, the potential risk of infection that may be associated with intra-articular and soft-tissue injections of corticosteroids has not been reported. The aim of this study was to assess the risk for infection following intra-articular or soft-tissue corticosteroid injections.
Self-controlled-risk-interval study with 15 732 adults who were treated with intra-articular or soft-tissue corticosteroid injections during 2015-2018. The study was conducted in a large Israeli Health Maintenance Organization. We self-matched the participants and analyzed the incidence of infection over three periods: an exposure-period of 90 days following the injection, and two 90-day control periods. We identified the occurrence of several common infections in the patient's electronic medical record and analyzed the incidence rates of all infections (composite end-point) as well as each infection separately.
The incidence of any infection was higher during postexposure period compared with the control periods (46.5 vs. 42.1 events per 1000 persons), number needed to harm was 227 persons. Self-matching analysis showed increased incidence-rate-ratio (IRR) for the combined incidence of infections in the post-exposure period compared with the control periods (IRR = 1.10, 95% confidence interval [CI] 1.01-1.21). A sensitivity analysis showed that the highest IRR was during the first 30 days (IRR = 1.19, 95% CI 1.03-1.38), with higher IRR for patients aged 65 years and older (IRR = 1.37, 95% CI 1.08-1.73).
Intra-articular and soft-tissue corticosteroids injections may be associated with an increased risk of infections; however, the absolute risk increase is low.
长期和短期口服皮质类固醇治疗与感染风险增加相关。然而，关节内和软组织皮质类固醇注射可能相关的感染潜在风险尚未报道。本研究旨在评估关节内或软组织皮质类固醇注射后感染的风险。
这是一项在 2015 年至 2018 年期间接受关节内或软组织皮质类固醇注射治疗的 15732 名成年人中进行的自我对照风险间隔研究。该研究在一家大型以色列医疗保健组织中进行。我们对参与者进行自我匹配，并分析了三个时期内的感染发生率：注射后 90 天的暴露期和两个 90 天的对照期。我们在患者的电子病历中确定了几种常见感染的发生情况，并分析了所有感染（复合终点）以及每种感染的发生率。
与对照期相比，暴露后时期任何感染的发生率更高（46.5 比 42.1 例/1000 人），需要伤害的人数为 227 人。自我匹配分析显示，与对照期相比，暴露后时期感染的综合发生率的发病率比（IRR）更高（IRR=1.10，95%置信区间[CI]为 1.01-1.21）。敏感性分析显示，在最初 30 天内 IRR 最高（IRR=1.19，95%CI 1.03-1.38），年龄在 65 岁及以上的患者的 IRR 更高（IRR=1.37，95%CI 1.08-1.73）。
关节内和软组织皮质类固醇注射可能与感染风险增加相关；然而，绝对风险增加是低的。
