Association between atopic dermatitis and serious cutaneous, multiorgan and systemic infections in US adults

Abstract

BackgroundAtopic dermatitis (AD) is associated with barrier disruption, immune dysregulation, and immunosuppressing treatments that can increase the association with an unusual number of infections. ObjectiveTo determine whether adults with AD have an unusually large number of serious infections and related outcomes. MethodsData from the 2002 to 2012 National Inpatient Sample were analyzed, including an approximately 20% sample of all US hospitalizations (n = 72,108,077 adults). Prevalence of serious infections in hospitalized patients with vs without AD, length of stay, cost of care, and inpatient mortality secondary to serious infections were determined. ResultsThe prevalence of serious infections expressed as a percentage (95% confidence interval) was higher in adults hospitalized with than in those without AD (42.1% [41.6–42.6] vs 25.4% [25.2–25.6]; P = .0002). In logistic regression models with multiple predictors (multivariable logistic regression models), AD was associated with 32 of 38 infections examined. Associated cutaneous infections included eczema herpeticum (odds ratio [95% confidence interval] adjusted for other predictors: 67.93 [47.93–96.28]), erysipelas (11.15 [9.47–13.1]), and cellulitis (4.53 [4.42–4.64]). Associated respiratory infections included aspergillosis (1.51 [1.21–1.88]) and tuberculosis (1.57 [1.41–1.76]). AD was associated with extracutaneous, multiorgan, and systemic infections, including infectious arthropathy (2.01 [1.84–2.20]), endocarditis (1.25 [1.12–1.39]), encephalitis (1.65 [1.40–1.96]), and methicillin-resistant Staphylococcus aureus infections (3.29 [3.17–3.42]). Patients with AD hospitalized with vs without any serious infection had an increased geometric mean cost of inpatient care ($8,273 [8,126–8,423] vs $7,179 [7,052–7,307]) and length of stay (5.3 days [5.2–5.3] vs 3.9 [3.9–4.0]; P = .0002), with $11 to $228 million excess annual costs from hospitalization with serious infections in adults with AD. ConclusionAdults with AD had increased cutaneous, respiratory, multiorgan, and systemic infections, which were associated with a considerable cost burden.