Staphylococcus aureus bacteremia in patients with rheumatoid arthritis - Data from the prospective INSTINCT cohort

被引：16

作者：

Joost, Insa ^{[1
]}

Kaasch, Achim ^{[2
,8
]}

Pausch, Christine ^{[3
]}

Peyerl-Hoffmann, Gabriele ^{[1
]}

Schneider, Christian ^{[4
]}

Voll, Reinhard E. ^{[5
]}

Seifert, Harald ^{[2
,6
]}

Kern, Winfried V. ^{[1
]}

Rieg, Siegbert ^{[1
,7
]}

机构：

[1] Univ Freiburg, Univ Med Ctr Freiburg, Fac Med, Div Infect Dis,Dept Med 2, Hugstetter Str 55, D-79106 Freiburg, Germany

[2] Univ Cologne, Inst Med Microbiol Immunol & Hyg, Goldenfelsstr 19, D-50937 Cologne, Germany

[3] Univ Leipzig, Inst Med Informat Stat & Epidemiol, Hartelstr 16-18, D-04107 Leipzig, Germany

[4] Univ Freiburg, Fac Med, Univ Med Ctr Freiburg, Inst Microbiol & Hyg, Hugstetter Str 55, D-79106 Freiburg, Germany

[5] Univ Freiburg, Fac Med, Univ Med Ctr Freiburg, Dept Rheumatol & Clin Immunol, Hugstetter Str 55, D-79106 Freiburg, Germany

[6] German Ctr Infect Res DZIF, Partner Site Bonn Cologne, Bonn, Germany

[7] Univ Freiburg, Univ Med Ctr Freiburg, Ctr Chron Immunodeficiency, Fac Med, Hugstetter Str 55, D-79106 Freiburg, Germany

[8] Heinrich Heine Univ Dusseldorf, Inst Med Microbiol & Hosp Hyg, Univ Str 1, D-40225 Dusseldorf, Germany

来源：

JOURNAL OF INFECTION | 2017年 / 74卷 / 06期

关键词：

Bloodstream infection; Osteoarticular infection; Immunosuppressive treatment; Bone and joint infections; Complicated bacteremia; Hematogenous dissemination; SEPTIC ARTHRITIS; RISK-FACTORS; INFECTION; MORTALITY; OSTEOMYELITIS; EPIDEMIOLOGY; PREDICTORS; THERAPY; SEPSIS; CELL;

D O I：

10.1016/j.jinf.2017.03.003

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objectives: Patients with rheumatoid arthritis (RA) are considered to be at increased risk of severe infections. We here describe the clinical characteristics, course and outcome of RA patients with Staphylococcus aureus bacteremia (SAB). Methods: We conducted a post hoc analysis of data from a German bi-center prospective SAB cohort study (period 2006-2014). Patients were followed-up for one year. Primary and secondary outcomes were survival time and osteoarticular infection (OAI). Results: A total of 1069 patients with SAB were analyzed, with 31 patients suffering from RA. RA patients showed significantly more often OAI (15/31 patients, 48% vs. 152/1038, 15%), disseminated infection (12/31, 39% vs. 164/1038, 16%) and severe sepsis/septic shock (12/31, 39% vs. 235/1038, 23%). Day-30 mortality in RA patients was 36% (vs. 19% in non-RA patients, p = 0.034), and day 90 mortality was 58% (vs. 32%, p = 0.003). Multivariate analyses confirmed RA to be an independent risk factor for death (HR 2.3, 95% CI 1.4-3.7) and OAI (OR 4.2, 95% CI 1.8-9.8). Conclusions: Patients with RA exhibit a complicated SAB course and a high mortality, their management is challenging. Adequate antibiotic treatment, prompt invasive diagnostic and therapeutic procedures like joint lavage or surgery are of pivotal importance. Joint damage due to RA may confer a higher risk of acquiring OAI than immunosuppression. (C) 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

引用

页码：575 / 584

页数：10

共 39 条

[1] Rates of Serious Infections and Malignancies Among Patients with Rheumatoid Arthritis Receiving Either Tumor Necrosis Factor Inhibitor or Rituximab Therapy [J].