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Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, matched-cohort data linkage study.
- Source :
-
Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2020 Oct 01; Vol. 59 (10), pp. 3014-3022. - Publication Year :
- 2020
-
Abstract
- Objectives: Infection exerts a major burden in ANCA-associated vasculitis (AAV), however, its precise extent and nature remains unclear. In this national study we aimed to longitudinally quantify, characterize and contextualize infection risk in AAV.<br />Methods: We conducted a multicentre matched cohort study of AAV. Complementary data on infections were retrieved via data linkage with the population-based Scottish microbiological laboratory, hospitalization and primary care prescribing registries.<br />Results: A total of 379 AAV patients and 1859 controls were followed up for a median of 3.5 years (interquartile range 1.9-5.7). During follow-up, the proportions of AAV patients with at least one laboratory-confirmed infection, severe infection and primary care antibiotic prescription were 55.4%, 35.6% and 74.6%, respectively. The risk of infection was higher in AAV than in matched controls {laboratory-confirmed infections: incidence rate ratio [IRR] 7.3 [95% confidence interval (CI) 5.6, 9.6]; severe infections: IRR 4.4 [95% CI 3.3, 5.7]; antibiotic prescriptions: IRR 2.2 [95% CI 1.9, 2.6]}. Temporal trend analysis showed that AAV patients remained at a higher risk of infections throughout the follow-up period, especially year 1. Although the Escherichia genus was the most commonly identified pathogen (16.6% of AAV, 5.5% of controls; P < 0.0001), AAV patients had the highest risk for Herpes [IRR 12.5 (95% CI 3.7, 42.6)] and Candida [IRR 11.4 (95% CI 2.4, 55.4)].<br />Conclusion: AAV patients have up to seven times higher risk of infection than the general population and the overall risk remains significant after 8 years of follow-up. The testing of enhanced short- to medium-term prophylactic antibiotic regimes should be considered.<br /> (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
- Subjects :
- Aged
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis complications
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis virology
Case-Control Studies
Churg-Strauss Syndrome complications
Churg-Strauss Syndrome microbiology
Churg-Strauss Syndrome virology
Female
Granulomatosis with Polyangiitis complications
Granulomatosis with Polyangiitis microbiology
Granulomatosis with Polyangiitis virology
Humans
Information Storage and Retrieval
Longitudinal Studies
Male
Microscopic Polyangiitis complications
Microscopic Polyangiitis microbiology
Microscopic Polyangiitis virology
Middle Aged
Registries
Risk
Scotland
Time Factors
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis microbiology
Bacterial Infections microbiology
Candidiasis microbiology
Herpesviridae Infections virology
Subjects
Details
- Language :
- English
- ISSN :
- 1462-0332
- Volume :
- 59
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Rheumatology (Oxford, England)
- Publication Type :
- Academic Journal
- Accession number :
- 32159801
- Full Text :
- https://doi.org/10.1093/rheumatology/keaa070