TOPLINE:

A study capturing 14-year data found that the use of oral glucocorticoids for chronic diseases was associated with higher odds of candidemia, with a dose-dependent risk, for most Candida species. The strongest association was observed in patients with inflammatory bowel disease (IBD) treated with glucocorticoids.

METHODOLOGY:

• Researchers conducted a nationwide, registry-based case-control study in Denmark using data from 2010 to 2024 to investigate whether the use of glucocorticoids is associated with increased odds of candidemia.
• A total of 6179 individuals with a first-time, laboratory-confirmed Candida bloodstream infection were matched by sex and age to 61,790 control individuals (median age, 70.7 years; 38.4% women).
• Glucocorticoid users were defined as individuals with at least one redeemed prescription for an oral glucocorticoid within 90 days before the blood culture was drawn; exposure was categorised on the basis of 90‑day prednisolone-equivalent cumulative doses (PECDs) as < 750, 750-1500, and > 1500 mg.
• Subgroup analyses evaluated variation by Candida species and underlying conditions including chronic pulmonary disease, rheumatic disease, and IBD.

TAKEAWAY:

• The use of glucocorticoids was associated with almost double the odds of candidemia overall (adjusted odds ratio [aOR], 2.17; 95% CI, 1.92-2.45) compared with non-use.
• A dose-dependent response was reported across PECD categories: < 750 mg (aOR, 1.59; 95% CI, 1.35-1.86), 750-1500 mg (aOR, 2.25; 95% CI, 1.75-2.90), and > 1500 mg (aOR, 5.23; 95% CI, 4.01-6.83).
• This association was observed across the major Candida species, including Candida albicans, C glabrata, C tropicalis, C krusei, and C parapsilosis.
• Patients with IBD on glucocorticoids were most likely to develop candidemia, followed by those with rheumatic disease and chronic pulmonary disease.

IN PRACTICE:

"Clinicians should be aware of candidemia risk when prescribing glucocorticoids, particularly at higher doses, with prolonged therapy, and among patients with inflammatory bowel disease," the authors wrote.

"Strategies to minimize unnecessary glucocorticoid exposure and identify high-risk patients may help reduce the burden of candidemia, while future studies should evaluate preventive strategies in selected populations," they added.

SOURCE:

This study was led by Cæcilie Leding, MD, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark. It was published online on May 30, 2026, in Clinical Microbiology and Infection.

LIMITATIONS:

Residual confounding, particularly by indication, cannot be excluded as individuals prescribed systemic glucocorticoids may be frailer or have higher disease activity. Exposure was based on redeemed outpatient prescriptions, so actual intake was unknown and in‑hospital glucocorticoid administration was not captured, potentially risking exposure misclassification. The study was observational and could not prove causality.

DISCLOSURES:

No specific funding was reported for the study. One author disclosed receiving grants and personal fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.