Opiates and Risk of Invasive Pneumococcus

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Opiate use was associated with invasive pneumococcal disease.  

Why does this matter?
Some patients abuse opiates, but some are on them chronically for good reasons, i.e. cancer.  It is important to know this association when opiate users or abusers arrive in the ED with a febrile illness, especially in those with no pneumococcal vaccination.

Yet another reason to be careful with opiates
The was a case control study using Tennessee surveillance databases.  They found 62% greater odds of current opiate use in patients (cases) with invasive pneumococcal disease (IPD).  This was adjusted for conditions known to increase risk of IPD, such as alcohol abuse, liver disease, sickle cell anemia, etc.  The association was even stronger in those taking long-acting, higher potency, or high dose opiates.  Immunosuppression from morphine and fentanyl have been known to occur in animal models, and other studies suggested increased risk of infection in humans as well.  This case-control adds more evidence that these drugs increase risk of infection, specifically IPD.

Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases: A Nested Case-Control Study. Ann Intern Med. 2018 Feb 13. doi: 10.7326/M17-1907. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

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