{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T17:02:15Z","timestamp":1775322135192,"version":"3.50.1"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Previous studies have suggested that infections are an important cause of death in patients with Addison's disease, but epidemiological studies on the frequency of infections in this population are lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess and compare the incidence risk of infections in patients with primary adrenal insufficiency with controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>We conducted a cohort study, using data from the Dutch PHARMO record linkage system, that links patients' demographics and medication histories to hospital admissions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>From a cohort of oral glucocorticoid users, 390 patients with primary adrenal insufficiency were identified by assessing concurrent use of glucocorticoids and mineralocorticoids using pharmacy dispensing records. A reference cohort (<jats:italic>n<\/jats:italic>=1933) with the same age and sex distribution was sampled from patients not using glucocorticoids.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measure<\/jats:title><jats:p>Incidence rates and incidence rate ratios (IRR) were calculated of infections, defined by use of antimicrobial agents, as well as hospital admissions for infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of infectious episodes, defined by usage of antimicrobial agents, among patients with primary adrenal insufficiency (incidence rate 59.2\/100 person-years) was 1.5 times higher compared with controls, yielding a crude IRR of 1.61 (95% CI 1.51\u20131.72). The IRR decreased slightly to 1.58 (95% CI 1.47\u20131.70) after adjustment for co-medication and co-morbidity also associated with infection risk. Also with respect to hospital admissions for infection, the incidence rates observed for patients with primary adrenal insufficiency was higher compared with controls (3.8\/100 vs 0.8\/100 person-years): crude IRR 5.02 (3.66\u20136.87) and adjusted IRR 4.34 (95% CI 3.04\u20136.22).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with primary adrenal insufficiency had an increased use of antimicrobial agents and hospital admissions related to infection.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-12-0879","type":"journal-article","created":{"date-parts":[[2013,2,6]],"date-time":"2013-02-06T05:08:14Z","timestamp":1360127294000},"page":"609-614","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":61,"title":["Increased use of antimicrobial agents and hospital admission for infections in patients with primary adrenal insufficiency: a cohort study"],"prefix":"10.1093","volume":"168","author":[{"given":"Lisanne C C J","family":"Smans","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick C","family":"Souverein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hubert G M","family":"Leufkens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andy I M","family":"Hoepelman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre M J","family":"Zelissen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","reference":[{"issue":"6","key":"1_17107323","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1046\/j.1365-2265.2002.t01-1-01552.x","volume":"56","author":"L\u00a0\u00a0v\u00a0\u00a0s","year":"2002","journal-title":"Clinical endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0300-0664","issn-type":"print"},{"issue":"5","key":"2_31815464","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1111\/j.1365-2265.2008.03340.x","volume":"69","author":"Bensing","year":"2008","journal-title":"Clinical endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0300-0664","issn-type":"print"},{"issue":"2","key":"3_32627725","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1530\/EJE-08-0550","volume":"160","year":"2009","journal-title":"European Journal of Endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0804-4643","issn-type":"print"},{"issue":"12","key":"4_22586018","doi-asserted-by":"publisher","first-page":"4849","DOI":"10.1210\/jc.2006-0076","volume":"91","year":"2006","journal-title":"Journal of Clinical Endocrinology &amp; 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