{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:46:46Z","timestamp":1765234006638,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Committee at Herlev and Gentofte University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Non-cystic fibrosis bronchiectasis (BE) is a chronic airway disease with increasing prevalence, reduced quality of life, and increased mortality. Inhaled corticosteroids (ICS) are used in BE despite limited evidence of effect on lung function parameters. ICS may increase the risk of Staphylococcus aureus (S. aureus) infections in patients with BE, but this is unexplored. We examined the association between ICS use prior to BE diagnosis at different doses and the risk of S. aureus isolation in patients with BE. Methods: We conducted a national register-based cohort study including Danish patients with a BE diagnosis code between 2001 and 2018 with a 1-year follow-up time from the date of diagnosis. ICS exposure was categorized based on accumulated prescriptions redeemed 365 days before BE diagnosis and divided into none, low, moderate, or high use based on clinically relevant doses. A cause-specific Cox proportional hazards regression model was used to estimate the risk of S. aureus isolation. A sensitivity analysis, an inverse probability of treatment weighted model (IPTW), was performed. Results: A total of 5093 patients were included in this study. S. aureus was isolated in 156 patients (3.1%). High-dose ICS was associated with an increased risk of S. aureus isolation, HR 3.81 (95% CI 2.51; 5.79). No association for low or moderate use was found, low-dose HR 1.22 (95% CI 0.77; 1.93), and moderate-dose HR 1.24 (95% CI 0.72; 2.16). IPTW analysis yielded similar results. Conclusions: High-dose ICS use in patients with BE was associated with an increased risk of S. aureus isolation. ICS should be used cautiously in patients with BE.<\/jats:p>","DOI":"10.3390\/jcm14155207","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T10:49:17Z","timestamp":1753267757000},"page":"5207","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Inhaled Corticosteroids and Risk of Staphylococcus aureus Isolation in Bronchiectasis: A Register-Based Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4162-4227","authenticated-orcid":false,"given":"Andrea Arlund","family":"Filipsen","sequence":"first","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4784-4696","authenticated-orcid":false,"given":"Karen Hougaard","family":"Frost","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3739-7526","authenticated-orcid":false,"given":"Josefin","family":"Ekl\u00f6f","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise Lindhardt","family":"T\u00f8nnesen","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Kubel","family":"Vognsen","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas Bredtoft","family":"Boel","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mette","family":"Pinholt","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Hvidovre University Hospital, 2650 Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian \u00d8stergaard","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Infectious Disease Preparedness, Statens Serum Institut, 2300 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1497-6309","authenticated-orcid":false,"given":"Ram Benny Christian","family":"Dessau","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Zealand University Hospital, 4200 Slagelse, Denmark"},{"name":"Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tor","family":"Biering-S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, 2900 Hellerup, Denmark"},{"name":"Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"},{"name":"Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofie Lock","family":"Johansson","sequence":"additional","affiliation":[{"name":"Section of Respiratory Medicine, Department of Medicine, Odense Universitetshospital, University of Southern Denmark, 5000 Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4036-0521","authenticated-orcid":false,"given":"Jens-Ulrik","family":"Jensen","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8620-3655","authenticated-orcid":false,"given":"Pradeesh","family":"Sivapalan","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/S2213-2600(21)00277-0","article-title":"Criteria and definitions for the radiological and clinical diagnosis of bronchiectasis in adults for use in clinical trials: International consensus recommendations","volume":"10","author":"Aliberti","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41572-018-0042-3","article-title":"Bronchiectasis","volume":"4","author":"Chalmers","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1016\/S0140-6736(18)31767-7","article-title":"Advances in bronchiectasis: Endotyping, genetics, microbiome, and disease heterogeneity","volume":"392","author":"Chalmers","year":"2018","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1183\/13993003.01033-2015","article-title":"Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: A population-based cohort study","volume":"47","author":"Quint","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1700629","DOI":"10.1183\/13993003.00629-2017","article-title":"European Respiratory Society guidelines for the management of adult bronchiectasis","volume":"50","author":"Polverino","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_6","first-page":"CD000996","article-title":"Inhaled corticosteroids for bronchiectasis","volume":"2018","author":"Kapur","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2400518","DOI":"10.1183\/13993003.00518-2024","article-title":"Bronchiectasis management in adults: State of the art and future directions","volume":"63","author":"Choi","year":"2024","journal-title":"Eur. Respir. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2775","DOI":"10.2147\/COPD.S116750","article-title":"The association between inhaled corticosteroid and pneumonia in COPD patients: The improvement of patients\u2019 life quality with COPD in Taiwan (IMPACT) study","volume":"11","author":"Wang","year":"2016","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"107962","DOI":"10.1016\/j.rmed.2025.107962","article-title":"Local and systemic adverse effects of inhaled corticosteroids - Does ciclesonide differ from other inhaled corticosteroids?","volume":"238","author":"Ottesen","year":"2025","journal-title":"Respir. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"373","DOI":"10.2147\/COPD.S386518","article-title":"Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease and Risk of Acquiring Streptococcus pneumoniae Infection. A Multiregional Epidemiological Study","volume":"18","author":"Heerfordt","year":"2023","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1136\/thoraxjnl-2021-217160","article-title":"Use of inhaled corticosteroids and risk of acquiring Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease","volume":"77","author":"Ingebrigtsen","year":"2022","journal-title":"Thorax"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e001726","DOI":"10.1136\/bmjresp-2023-001726","article-title":"Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease","volume":"10","author":"Johnsen","year":"2023","journal-title":"BMJ Open Respir. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1177\/1403494811401482","article-title":"The Danish national patient register","volume":"39","author":"Lynge","year":"2011","journal-title":"Scand. J. Public. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1177\/1403494810394717","article-title":"The Danish national prescription registry","volume":"39","author":"Kildemoes","year":"2011","journal-title":"Scand. J. Public. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s10654-014-9930-3","article-title":"The Danish Civil Registration System as a tool in epidemiology","volume":"29","author":"Schmidt","year":"2014","journal-title":"Eur. J. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Thygesen, S.K., Christiansen, C.F., Christensen, S., Lash, T.L., and S\u00f8rensen, H.T. (2011). The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients. BMC Med. Res. Methodol., 11.","DOI":"10.1186\/1471-2288-11-83"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies","volume":"40","author":"Charlson","year":"1987","journal-title":"Development and Validation. J. Chronic Dis."},{"key":"ref_18","unstructured":"The National Institute for Health and Care Excellence (NICE) (2017). Asthma: Diagnosis, Monitoring and Chronic Asthma Management. NICE Guidance, The National Institute for Health and Care Excellence (NICE). Available online: https:\/\/www.nice.org.uk\/guidance\/ng245\/resources\/asthma-diagnosis-monitoring-and-chronic-asthma-management-bts-nice-sign-pdf-66143958279109."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/ckj\/sfab158","article-title":"An introduction to inverse probability of treatment weighting in observational research","volume":"15","author":"Chesnaye","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_20","unstructured":"Sjoberg, D.D., Baillie, M., Fruechtenicht, C., Haesendonckx, S., and Treis, T. (2025, May 21). Ggsurvfit: Flexible Time-to-Event Figures. Available online: https:\/\/github.com\/pharmaverse\/ggsurvfit."},{"key":"ref_21","unstructured":"Cefalu, M., Ridgeway, G., McCaffrey, D., Morral, A., Griffin, B.A., and Burgette, L. (2025, May 06). Twang: Toolkit for Weighting and Analysis of Nonequivalent Groups. Available online: https:\/\/cran.r-project.org\/web\/packages\/twang\/index.html."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.2147\/COPD.S132961","article-title":"Bronchiectasis in COPD patients: More than a comorbidity?","volume":"12","author":"Miravitlles","year":"2017","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1177\/1941874412458678","article-title":"Glucocorticoids: Complications to Anticipate and Prevent","volume":"3","author":"Gensler","year":"2013","journal-title":"Neurohospitalist"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"108208","DOI":"10.1016\/j.rmed.2025.108208","article-title":"Bronchiectasis after allogeneic hematopoietic cell transplantation\u2013an underdiagnosed complication","volume":"245","author":"Freund","year":"2025","journal-title":"Respir. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1186\/s12931-019-1242-4","article-title":"Primary immunodeficiency-related bronchiectasis in adults: Comparison with bronchiectasis of other etiologies in a French reference center","volume":"20","author":"Goussault","year":"2019","journal-title":"Respir. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1183\/09031936.06.00125404","article-title":"Corticosteroid effects on cell signalling","volume":"27","author":"Barnes","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"eaav3879","DOI":"10.1126\/scitranslmed.aav3879","article-title":"Inhaled corticosteroid suppression of cathelicidin drives dysbiosis and bacterial infection in chronic obstructive pulmonary disease","volume":"11","author":"Singanayagam","year":"2019","journal-title":"Sci. Transl. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1700451","DOI":"10.1183\/13993003.00451-2017","article-title":"Long-term effects of inhaled corticosteroids on sputum bacterial and viral loads in COPD","volume":"50","author":"Contoli","year":"2017","journal-title":"Eur. Respir. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5207\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:14:26Z","timestamp":1760033666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5207"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,23]]},"references-count":28,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14155207"],"URL":"https:\/\/doi.org\/10.3390\/jcm14155207","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,7,23]]}}}