Risk of systemic infections requiring hospitalization in children with atopic dermatitis: a Danish retrospective nationwide cohort study
Summary 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 regi...
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| Veröffentlicht in: | British journal of dermatology (1951) 2021-07, Vol.185 (1), p.119-129 |
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| container_title | British journal of dermatology (1951) |
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| creator | Droitcourt, C. Vittrup, I. Dupuy, A. Egeberg, A. Thyssen, J.P. |
| description | Summary
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 |
| doi_str_mv | 10.1111/bjd.19825 |
| format | Article |
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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.
What is already known about this topic?
A number of studies have suggested an association between atopic dermatitis (AD) and extracutaneous infections in children; however, they are based on self‐report questionnaires or focused on outpatient infectious diseases.
What does this study add?
Children with AD have an increased risk of systemic infections requiring hospitalization, including respiratory tract, gastrointestinal, urinary tract and musculoskeletal infections.
The associations remained, even after considering atopic comorbidities and immunosuppressant treatment for AD.
Linked Comment: M. Linder. Br J Dermatol 2021; 185:11–12.</description><identifier>ISSN: 0007-0963</identifier><identifier>EISSN: 1365-2133</identifier><identifier>DOI: 10.1111/bjd.19825</identifier><identifier>PMID: 33476408</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Atopic dermatitis ; Children ; Cohort analysis ; Dermatitis ; Dermatology ; Diagnosis ; Eczema ; Hospitalization ; Human health and pathology ; Infections ; Life Sciences ; Respiration ; Systemic diseases ; Urinary tract</subject><ispartof>British journal of dermatology (1951), 2021-07, Vol.185 (1), p.119-129</ispartof><rights>2021 British Association of Dermatologists</rights><rights>2021 British Association of Dermatologists.</rights><rights>Copyright © 2021 British Association of Dermatologists</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4225-c9da7e2d5c7a29da2552c1b6c524a6b19f6f43e63c6618caa0d61492561477183</citedby><cites>FETCH-LOGICAL-c4225-c9da7e2d5c7a29da2552c1b6c524a6b19f6f43e63c6618caa0d61492561477183</cites><orcidid>0000-0001-6714-6643 ; 0000-0001-8257-1816</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbjd.19825$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbjd.19825$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33476408$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-03129777$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Droitcourt, C.</creatorcontrib><creatorcontrib>Vittrup, I.</creatorcontrib><creatorcontrib>Dupuy, A.</creatorcontrib><creatorcontrib>Egeberg, A.</creatorcontrib><creatorcontrib>Thyssen, J.P.</creatorcontrib><title>Risk of systemic infections requiring hospitalization in children with atopic dermatitis: a Danish retrospective nationwide cohort study</title><title>British journal of dermatology (1951)</title><addtitle>Br J Dermatol</addtitle><description>Summary
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.
What is already known about this topic?
A number of studies have suggested an association between atopic dermatitis (AD) and extracutaneous infections in children; however, they are based on self‐report questionnaires or focused on outpatient infectious diseases.
What does this study add?
Children with AD have an increased risk of systemic infections requiring hospitalization, including respiratory tract, gastrointestinal, urinary tract and musculoskeletal infections.
The associations remained, even after considering atopic comorbidities and immunosuppressant treatment for AD.
Linked Comment: M. Linder. Br J Dermatol 2021; 185:11–12.</description><subject>Atopic dermatitis</subject><subject>Children</subject><subject>Cohort analysis</subject><subject>Dermatitis</subject><subject>Dermatology</subject><subject>Diagnosis</subject><subject>Eczema</subject><subject>Hospitalization</subject><subject>Human health and pathology</subject><subject>Infections</subject><subject>Life Sciences</subject><subject>Respiration</subject><subject>Systemic diseases</subject><subject>Urinary tract</subject><issn>0007-0963</issn><issn>1365-2133</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kcuOFCEUhonROO3owhcwJG50UTMHKKDK3VzU0XRiYnRNaKAs2qqiB6jptE_gY0tPj70wkQUQ-M7H5UfoJYEzUtr5am3PSNtQ_ggtCBO8ooSxx2gBALKCVrAT9CylNQBhwOEpOmGslqKGZoF-f_XpJw4dTruU3egN9lPnTPZhSji629lHP_3AfUgbn_Xgf-n9VoGw6f1go5vw1uce6xw2pdi6OBYi-_QOa3ytJ5_6osmx1O-tdw5P94attw6b0IeYccqz3T1HTzo9JPfiYTxF3z-8_3Z1Uy2_fPx0dbGsTE0pr0xrtXTUciM1LXPKOTVkJQyntRYr0naiq5kTzAhBGqM1WEHqlvLSS0kadoreHry9HtQm-lHHnQraq5uLpdqvASO0lVLekcK-ObCbGG5nl7IafTJuGPTkwpwUrRugLZdAC_r6H3Qd5jiVlyjKa9kANCWT4-GmfEiKrjvegIDaR6lKlOo-ysK-ejDOq9HZI_k3uwKcH4CtH9zu_yZ1-fn6oPwDp5apHQ</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Droitcourt, C.</creator><creator>Vittrup, I.</creator><creator>Dupuy, A.</creator><creator>Egeberg, A.</creator><creator>Thyssen, J.P.</creator><general>Oxford University Press</general><general>Wiley</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><orcidid>https://orcid.org/0000-0001-6714-6643</orcidid><orcidid>https://orcid.org/0000-0001-8257-1816</orcidid></search><sort><creationdate>202107</creationdate><title>Risk of systemic infections requiring hospitalization in children with atopic dermatitis: a Danish retrospective nationwide cohort study</title><author>Droitcourt, C. ; Vittrup, I. ; Dupuy, A. ; Egeberg, A. ; Thyssen, J.P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4225-c9da7e2d5c7a29da2552c1b6c524a6b19f6f43e63c6618caa0d61492561477183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Atopic dermatitis</topic><topic>Children</topic><topic>Cohort analysis</topic><topic>Dermatitis</topic><topic>Dermatology</topic><topic>Diagnosis</topic><topic>Eczema</topic><topic>Hospitalization</topic><topic>Human health and pathology</topic><topic>Infections</topic><topic>Life Sciences</topic><topic>Respiration</topic><topic>Systemic diseases</topic><topic>Urinary tract</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Droitcourt, C.</creatorcontrib><creatorcontrib>Vittrup, I.</creatorcontrib><creatorcontrib>Dupuy, A.</creatorcontrib><creatorcontrib>Egeberg, A.</creatorcontrib><creatorcontrib>Thyssen, J.P.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><jtitle>British journal of dermatology (1951)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Droitcourt, C.</au><au>Vittrup, I.</au><au>Dupuy, A.</au><au>Egeberg, A.</au><au>Thyssen, J.P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of systemic infections requiring hospitalization in children with atopic dermatitis: a Danish retrospective nationwide cohort study</atitle><jtitle>British journal of dermatology (1951)</jtitle><addtitle>Br J Dermatol</addtitle><date>2021-07</date><risdate>2021</risdate><volume>185</volume><issue>1</issue><spage>119</spage><epage>129</epage><pages>119-129</pages><issn>0007-0963</issn><eissn>1365-2133</eissn><abstract>Summary
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.
What is already known about this topic?
A number of studies have suggested an association between atopic dermatitis (AD) and extracutaneous infections in children; however, they are based on self‐report questionnaires or focused on outpatient infectious diseases.
What does this study add?
Children with AD have an increased risk of systemic infections requiring hospitalization, including respiratory tract, gastrointestinal, urinary tract and musculoskeletal infections.
The associations remained, even after considering atopic comorbidities and immunosuppressant treatment for AD.
Linked Comment: M. Linder. Br J Dermatol 2021; 185:11–12.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>33476408</pmid><doi>10.1111/bjd.19825</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-6714-6643</orcidid><orcidid>https://orcid.org/0000-0001-8257-1816</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Access via Wiley Online Library; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Atopic dermatitis Children Cohort analysis Dermatitis Dermatology Diagnosis Eczema Hospitalization Human health and pathology Infections Life Sciences Respiration Systemic diseases Urinary tract |
| title | Risk of systemic infections requiring hospitalization in children with atopic dermatitis: a Danish retrospective nationwide cohort study |
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