{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T12:31:32Z","timestamp":1770813092104,"version":"3.50.1"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The dose-dependent risk of opportunistic fungal infections and associated mortality from systemic glucocorticoids remains poorly defined in non-HIV, non-transplant (NHNT) populations. This study evaluated the cumulative incidence of opportunistic fungal infections and the association between glucocorticoid dose, infection risk, and 1-year mortality in NHNT adults. In this observational cohort study (NCT05707156), adults without HIV or solid organ transplants who received systemic glucocorticoids for\u00a0\u226514 days between 2022 and 2024 were identified using the TriNetX research network. Glucocorticoid doses, standardized to prednisone equivalents (PEQ), were categorized as\u00a0\u226410\u00a0mg\/day, 11\u201320\u00a0mg\/day, and\u00a0&amp;gt;20\u00a0mg\/day based on clinically relevant thresholds. Cumulative duration beyond the initial\u00a0\u226514 days was unavailable. Multivariable logistic regression identified predictors of opportunistic fungal infections. Cox proportional hazards and Kaplan\u2013Meier analyses evaluated associations between glucocorticoid dose and 1-year all-cause mortality. Among 7839 patients, 6% developed opportunistic fungal infections, predominantly histoplasmosis (96%). Compared with \u226410\u00a0mg\/day, neither 11\u201320\u00a0mg\/day (OR 0.85, 95% CI 0.18\u20133.91) nor &amp;gt;20\u00a0mg\/day (OR 0.89, 95% CI 0.24\u20133.33) was independently associated with infection risk. Crude 1-year mortality was higher in the &amp;gt;20\u00a0mg group (1.1%) versus \u226410\u00a0mg (0.5%) and 11\u201320\u00a0mg (0.4%) groups (P =\u00a0.002), but glucocorticoid dose was not independently associated with mortality after adjustment. Increased mortality was associated with older age (HR 1.03\/year), female sex (HR 1.96), and higher Charlson Comorbidity Index (HR 1.17 per point). Higher glucocorticoid doses did not independently predict opportunistic fungal infection risk or mortality, illustrating the limitations of dose-based risk stratification.<\/jats:p>","DOI":"10.1093\/mmy\/myag008","type":"journal-article","created":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T12:48:35Z","timestamp":1769258915000},"source":"Crossref","is-referenced-by-count":0,"title":["Opportunistic fungal infection risk and mortality in non-HIV, non-transplant US adults receiving systemic glucocorticoids: An observational cohort study"],"prefix":"10.1093","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4018-0195","authenticated-orcid":false,"given":"Daniel B","family":"Chastain","sequence":"first","affiliation":[{"name":"University of Georgia College of Pharmacy Department of Clinical and Administrative Pharmacy, , Augusta, Georgia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8518-5750","authenticated-orcid":false,"given":"George R","family":"Thompson","sequence":"additional","affiliation":[{"name":"University of California Department of Medicine, Division of Infectious Diseases, Davis Medical Center, , Sacramento, California ,","place":["USA"]},{"name":"University of California Department of Medical Microbiology and Immunology, Davis Medical Center, , Sacramento, California ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya","family":"Tuo","sequence":"additional","affiliation":[{"name":"University of Michigan Health System Department of Orthopedic Surgery, , Ann Arbor, Michigan ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-8652","authenticated-orcid":false,"given":"Andr\u00e9s F","family":"Henao-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"University of Colorado, Anschutz Medical Campus Department of Medicine, Division of Infectious Diseases, , Aurora, Colorado ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"issue":"8","key":"2026020903164229500_bib1","doi-asserted-by":"publisher","first-page":"ofae415","DOI":"10.1093\/ofid\/ofae415","article-title":"Higher prevalence of immunosuppression among US adults: implications for coronavirus disease 2019 and respiratory pathogen vaccinations","volume":"11","author":"Li","year":"2024","journal-title":"Open Forum Infect Dis"},{"issue":"5","key":"2026020903164229500_bib2","doi-asserted-by":"publisher","first-page":"e214920","DOI":"10.1001\/jamanetworkopen.2021.4920","article-title":"Prevalence of immunosuppressive drug use among commercially insured US adults, 2018\u20132019","volume":"4","author":"Wallace","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"3","key":"2026020903164229500_bib3","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1530\/EJE-19-0305","article-title":"Fifteen-year nationwide trends in systemic glucocorticoid drug use in Denmark","volume":"181","author":"Laugesen","year":"2019","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"2026020903164229500_bib4","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1002\/acr.21796","article-title":"Prevalence of oral glucocorticoid usage in the United States: a general population perspective","volume":"65","author":"Overman","year":"2013","journal-title":"Arthritis Care Res"},{"issue":"3","key":"2026020903164229500_bib5","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1038\/s41584-020-0371-y","article-title":"Therapeutic glucocorticoids: mechanisms of actions in rheumatic diseases","volume":"16","author":"Hardy","year":"2020","journal-title":"Nat Rev Rheumatol"},{"issue":"4","key":"2026020903164229500_bib6","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.1093\/cid\/ciad474","article-title":"Unintended consequences: risk of opportunistic infections associated with long-term glucocorticoid therapies in adults","volume":"78","author":"Chastain","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"5","key":"2026020903164229500_bib7","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1016\/0002-9343(81)90363-6","article-title":"Prednisone-induced leukocytosis. 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