Risk of Systemic Infections Requiring Hospitalization in Children With AD

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• This nationwide Danish registry–based cohort included 19,415 children with and 194,150 children without atopic dermatitis (AD). The incidence of all categories of systemic infections requiring hospitalization was increased for children with AD, and this association did not vary significantly with severity of AD.

• Compared with children without AD, children with AD are at increased risk of developing lower respiratory (aHR, 1.79), upper respiratory (aHR, 1.59), gastrointestinal (aHR, 1.24), urinary tract (aHR, 1.34), and musculoskeletal (aHR, 1.33) infections that require hospitalization.

– Caroline K. Crabtree, MD

Abstract 

BACKGROUND

Certain infections can trigger worsening of atopic dermatitis (AD). Further, an increased risk of extra-cutaneous infections has been suggested among children with AD, but data are sparse.

OBJECTIVES

To examine whether hospital managed pediatric AD is associated with increased risk of extra-cutaneous infections in childhood requiring hospitalisation.

METHODS

Nationwide based cohort study using Danish registries. All children aged under 18 years with a hospital in- or outpatient diagnosis of AD and reference children without hospital diagnosis of AD were matched on gender and age at first AD diagnosis date (1:10). Children were included from January 1, 1995 to December 31, 2016 and followed up until December 31, 2017. Study outcomes were extra-cutaneous infections that lead to hospitalisation. The severity of AD was defined by dispensations of AD treatments.

RESULTS

Of 19,415 AD children (median follow-up 7.4, interquartile range (IQR) 3.3-13.3 years) and 194,150 non-AD children (median follow-up 7.7, IQR 3.6-13.5 years), 56% were boys and 50% aged under 2 years. In adjusted analyses, children with AD had increased occurence of lower respiratory (aHR (adjusted hazard ratio)=1.79, 95% confidence interval (CI95%) 1.65-1.94), upper respiratory (aHR=1.59, CI95% 1.34-1.88), urinary tract (aHR=1.34 CI95% 1.16-1.54), musculoskeletal (aHR=1.33 CI95% CI95% 1.06-1.66), and gastrointestinal infections (aHR=1.24, CI95% 1.14-1.35), compared with children without a hospital diagnosis of AD. The associations did not clearly vary with the AD severity. The absolute risk difference per 10,000 person-years was 26.4 (CI95% 23.0-29.8) for lower respiratory, 3.1 (CI95% 1.6-4.7) for upper respiratory, 3.6 (CI95% 1.8-5.4) for urinary tract, 0.9 (CI95% 0.2-2.0) for musculoskeletal and 8.7 (CI95% 5.7-11.7) for gastrointestinal infections.

CONCLUSIONS

Children with hospital-managed AD have an increased risk of systemic infections that lead to hospitalization. The absolute risk was generally low.

The British Journal of Dermatology

The Risk of Systemic Infections Requiring Hospitalisation in Children With Atopic Dermatitis: A Danish Retrospective Nationwide Cohort Study

Br J Dermatol 2021 Jan 21;[EPub Ahead of Print], C Droitcourt, I Vittrup, A Dupuy, A Egeberg, JP Thyssen

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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