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Erschienen in: Clinical Rheumatology 2/2020

02.10.2019 | Original Article

Infectious profile in inpatients with ANCA-associated vasculitis: a single-center retrospective study from Southern China

verfasst von: Minxi Lao, Mingcheng Huang, Chen Li, Hao Li, Qian Qiu, Zhongping Zhan, Dongying Chen

Erschienen in: Clinical Rheumatology | Ausgabe 2/2020

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Abstract

Objectives

Infection is a common complication in ANCA-associated vasculitis (AAV). The study goal was to investigate the infectious profile in patients with AAV from Southern China.

Methods

A retrospective study was performed on the inpatients from the First Affiliated Hospital of Sun Yat-sen University from 2012 to 2017. Demographic and clinical characteristics were recorded.

Results

A total of 132 AAV inpatients with 174 episodes of infection (prevalence, 63.8%) were included. Lung was the most commonly involved. Ninety-six (72.7%) patients developed infection during the first 6 months after AAV diagnosis. Bacteria (75.9%) were the prominent microbes. Gram-negative bacteria were predominant (71.4%). The most frequently isolated bacteria were P. aeruginosa (16.7%) and A. baumannii (16.7%). Mixed infection accounted for 14.9% of the episodes, while fungal infection accounted for 6.3%. Mortality rate was 12.9% (17/132). Six deceased patients (46.2%) were infected with multiple pathogens. In multivariate analysis, smoking (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.13–5.03, P = 0.02), kidney involvement (OR 2.56, 95% CI 1.11–5.88, P = 0.03), lymphopenia (OR 2.33, 95% CI 1.20–4.55, P = 0.01), and dialysis (OR 3.06, 95% CI 1.14–8.20, P = 0.03) were associated with infection in patients with AAV.

Conclusions

Bacteria, especially Gram-negative bacteria, were the major pathogens in Chinese AAV patients. Mixed infection was a great threat to death. Infection tended to develop within the 6 months after AAV diagnosis. Smoking, kidney involvement, dialysis, and lymphopenia increased the risk of infection in patients with AAV.
Key Points
• Infection tended to develop within the 6 months after AAV diagnosis.
• Gram-negative bacteria were the leading pathogens.
• Smoking, kidney involvement, dialysis, and lymphopenia increased the risk of infection in patients with AAV.
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Literatur
1.
Zurück zum Zitat Flossmann O, Berden A, de Groot K, Hagen C, Harper L, Heijl C, Höglund P, Jayne D, Luqmani R, Mahr A, Mukhtyar C, Pusey C, Rasmussen N, Stegeman C, Walsh M, Westman K, European Vasculitis Study Group (2011) Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis 70(3):488–494. https://doi.org/10.1136/ard.2010.137778 CrossRefPubMed Flossmann O, Berden A, de Groot K, Hagen C, Harper L, Heijl C, Höglund P, Jayne D, Luqmani R, Mahr A, Mukhtyar C, Pusey C, Rasmussen N, Stegeman C, Walsh M, Westman K, European Vasculitis Study Group (2011) Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis 70(3):488–494. https://​doi.​org/​10.​1136/​ard.​2010.​137778 CrossRefPubMed
2.
Zurück zum Zitat Ribi C, Cohen P, Pagnoux C, Mahr A, Arène JP, Puéchal X, Carli P, Kyndt X, Le Hello C, Letellier P, Cordier JF, Guillevin L, French Vasculitis Study Group (2010) Treatment of polyarteritis nodosa and microscopic polyangiitis without poor-prognosis factors: a prospective randomized study of one hundred twenty-four patients. Arthritis Rheum 62(4):1186–1197. https://doi.org/10.1002/art.27340 CrossRefPubMed Ribi C, Cohen P, Pagnoux C, Mahr A, Arène JP, Puéchal X, Carli P, Kyndt X, Le Hello C, Letellier P, Cordier JF, Guillevin L, French Vasculitis Study Group (2010) Treatment of polyarteritis nodosa and microscopic polyangiitis without poor-prognosis factors: a prospective randomized study of one hundred twenty-four patients. Arthritis Rheum 62(4):1186–1197. https://​doi.​org/​10.​1002/​art.​27340 CrossRefPubMed
4.
Zurück zum Zitat Reinhold-Keller E, Beuge N, Latza U, de Groot K, Rudert H, Nölle B, Heller M, Gross WL (2000) An interdisciplinary approach to the care of patients with Wegener’s granulomatosis-long-term outcome in 155 patients. Arthritis Rheum 43(5):1021–1032CrossRefPubMed Reinhold-Keller E, Beuge N, Latza U, de Groot K, Rudert H, Nölle B, Heller M, Gross WL (2000) An interdisciplinary approach to the care of patients with Wegener’s granulomatosis-long-term outcome in 155 patients. Arthritis Rheum 43(5):1021–1032CrossRefPubMed
5.
Zurück zum Zitat Garen T, Lerang K, Hoffmann-Vold AM, Andersson H, Midtvedt Ø, Brunborg C, Kilian K, Gudbrandsson B, Gunnarsson R, Norby G, Chaudhary A, Thoen J, Forseth KØ, Fresjar K, Førre Ø, Haugen M, Haga HJ, Gran JT, Gilboe IM, Molberg Ø, Palm Ø (2018) Mortality and causes of death across the systemic connective tissue diseases and the primary systemic vasculitides. Rheumatology (Oxford) 58(2):313–320. https://doi.org/10.1093/rheumatology/key285 CrossRef Garen T, Lerang K, Hoffmann-Vold AM, Andersson H, Midtvedt Ø, Brunborg C, Kilian K, Gudbrandsson B, Gunnarsson R, Norby G, Chaudhary A, Thoen J, Forseth KØ, Fresjar K, Førre Ø, Haugen M, Haga HJ, Gran JT, Gilboe IM, Molberg Ø, Palm Ø (2018) Mortality and causes of death across the systemic connective tissue diseases and the primary systemic vasculitides. Rheumatology (Oxford) 58(2):313–320. https://​doi.​org/​10.​1093/​rheumatology/​key285 CrossRef
8.
Zurück zum Zitat Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CG et al (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37(2):187–192CrossRefPubMed Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CG et al (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37(2):187–192CrossRefPubMed
9.
Zurück zum Zitat Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CG, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DG, Specks U, Stone JH, Takahashi K, Watts RA (2013) 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65(1):1–11. https://doi.org/10.1002/art.37715 CrossRefPubMed Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CG, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DG, Specks U, Stone JH, Takahashi K, Watts RA (2013) 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65(1):1–11. https://​doi.​org/​10.​1002/​art.​37715 CrossRefPubMed
10.
Zurück zum Zitat Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18(3):268–281. https://doi.org/10.1111/j.1469-0691.2011.03570.x CrossRefPubMed Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18(3):268–281. https://​doi.​org/​10.​1111/​j.​1469-0691.​2011.​03570.​x CrossRefPubMed
11.
Zurück zum Zitat De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE (2008) European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group (2008) revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses. Clin Infect Dis 46(12):1813–1821. https://doi.org/10.1086/588660 CrossRefPubMed De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE (2008) European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group (2008) revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses. Clin Infect Dis 46(12):1813–1821. https://​doi.​org/​10.​1086/​588660 CrossRefPubMed
12.
Zurück zum Zitat Luqmani RA, Bacon PA, Moots RJ, Janssen BA, Pall A, Emery P, Emery P, Savage C, Adu D (1994) Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. QJM 87(11):671–678PubMed Luqmani RA, Bacon PA, Moots RJ, Janssen BA, Pall A, Emery P, Emery P, Savage C, Adu D (1994) Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. QJM 87(11):671–678PubMed
13.
Zurück zum Zitat Specks U, Merkel PA, Seo P, Spiera R, Langford CA, Hoffman GS, Kallenberg CG, St Clair EW, Fessler BJ, Ding L, Viviano L, Tchao NK, Phippard DJ, Asare AL, Lim N, Ikle D, Jepson B, Brunetta P, Allen NB, Fervenza FC, Geetha D, Keogh K, Kissin EY, Monach PA, Peikert T, Stegeman C, Ytterberg SR, Mueller M, Sejismundo LP, Mieras K, Stone JH, RAVE-ITN Research Group (2013) Efficacy of remission-induction regimens for ANCA-associated vasculitis. N Engl J Med 369(5):417–427. https://doi.org/10.1056/NEJMoa1213277 CrossRefPubMedPubMedCentral Specks U, Merkel PA, Seo P, Spiera R, Langford CA, Hoffman GS, Kallenberg CG, St Clair EW, Fessler BJ, Ding L, Viviano L, Tchao NK, Phippard DJ, Asare AL, Lim N, Ikle D, Jepson B, Brunetta P, Allen NB, Fervenza FC, Geetha D, Keogh K, Kissin EY, Monach PA, Peikert T, Stegeman C, Ytterberg SR, Mueller M, Sejismundo LP, Mieras K, Stone JH, RAVE-ITN Research Group (2013) Efficacy of remission-induction regimens for ANCA-associated vasculitis. N Engl J Med 369(5):417–427. https://​doi.​org/​10.​1056/​NEJMoa1213277 CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat McGregor JG, Negrete-Lopez R, Poulton CJ, Kidd JM, Katsanos SL, Goetz L, Hu Y, Nachman PH, Falk RJ, Hogan SL (2015) Adverse events and infectious burden, microbes and temporal outline from immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis with native renal function. Nephrol Dial Transplant 30:i171–i181. https://doi.org/10.1093/ndt/gfv045 CrossRefPubMedPubMedCentral McGregor JG, Negrete-Lopez R, Poulton CJ, Kidd JM, Katsanos SL, Goetz L, Hu Y, Nachman PH, Falk RJ, Hogan SL (2015) Adverse events and infectious burden, microbes and temporal outline from immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis with native renal function. Nephrol Dial Transplant 30:i171–i181. https://​doi.​org/​10.​1093/​ndt/​gfv045 CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Itabashi M, Takei T, Yabuki Y, Suzuki H, Ando M, Akamatsu M, Yamazaki M, Mitobe M, Watanabe Y, Mochizuki T, Nitta K (2010) Clinical outcome and prognosis of anti-neutrophil cytoplasmic antibody-associated vasculitis in Japan. Nephron Clin Pract 115(1):c21–c27. https://doi.org/10.1159/000286346 CrossRefPubMed Itabashi M, Takei T, Yabuki Y, Suzuki H, Ando M, Akamatsu M, Yamazaki M, Mitobe M, Watanabe Y, Mochizuki T, Nitta K (2010) Clinical outcome and prognosis of anti-neutrophil cytoplasmic antibody-associated vasculitis in Japan. Nephron Clin Pract 115(1):c21–c27. https://​doi.​org/​10.​1159/​000286346 CrossRefPubMed
19.
20.
Zurück zum Zitat Harper L, Morgan MD, Walsh M, Hoglund P, Westman K, Flossmann O, Tesar V, Vanhille P, de Groot K, Luqmani R, Flores-Suarez LF, Watts R, Pusey C, Bruchfeld A, Rasmussen N, Blockmans D, Savage CO, Jayne D, investigators EUVAS (2012) Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis: long-term follow-up. Ann Rheum Dis 71(6):955–960. https://doi.org/10.1136/annrheumdis-2011-200477 CrossRefPubMed Harper L, Morgan MD, Walsh M, Hoglund P, Westman K, Flossmann O, Tesar V, Vanhille P, de Groot K, Luqmani R, Flores-Suarez LF, Watts R, Pusey C, Bruchfeld A, Rasmussen N, Blockmans D, Savage CO, Jayne D, investigators EUVAS (2012) Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis: long-term follow-up. Ann Rheum Dis 71(6):955–960. https://​doi.​org/​10.​1136/​annrheumdis-2011-200477 CrossRefPubMed
21.
Zurück zum Zitat Chen YX, Yu HJ, Zhang W, Ren H, Chen XN, Shen PY, Xu YW, Li X, Pan XX, Ni LY, Wang WM, Chen N (2008) Analyzing fatal cases of Chinese patients with primary antineutrophil cytoplasmic antibodies-associated renal vasculitis: a 10-year retrospective study. Kidney Blood Press Res 31(5):343–349. https://doi.org/10.1159/000165117 CrossRefPubMed Chen YX, Yu HJ, Zhang W, Ren H, Chen XN, Shen PY, Xu YW, Li X, Pan XX, Ni LY, Wang WM, Chen N (2008) Analyzing fatal cases of Chinese patients with primary antineutrophil cytoplasmic antibodies-associated renal vasculitis: a 10-year retrospective study. Kidney Blood Press Res 31(5):343–349. https://​doi.​org/​10.​1159/​000165117 CrossRefPubMed
22.
Zurück zum Zitat Tsoumakidou M, Elston W, Zhu J, Wang Z, Gamble E, Siafakas NM, Barnes NC, Jeffery PK (2007) Cigarette smoking alters bronchial mucosal immunity in asthma. Am J Respir Crit Care Med 175(9):919–925CrossRefPubMed Tsoumakidou M, Elston W, Zhu J, Wang Z, Gamble E, Siafakas NM, Barnes NC, Jeffery PK (2007) Cigarette smoking alters bronchial mucosal immunity in asthma. Am J Respir Crit Care Med 175(9):919–925CrossRefPubMed
23.
Zurück zum Zitat Weidanz F, Day CJ, Hewins P, Savage CO, Harper L (2007) Recurrences and infections during continuous immunosuppressive therapy after beginning dialysis in ANCA-associated vasculitis. Am J Kidney Dis 50(1):36–46CrossRefPubMed Weidanz F, Day CJ, Hewins P, Savage CO, Harper L (2007) Recurrences and infections during continuous immunosuppressive therapy after beginning dialysis in ANCA-associated vasculitis. Am J Kidney Dis 50(1):36–46CrossRefPubMed
Metadaten
Titel
Infectious profile in inpatients with ANCA-associated vasculitis: a single-center retrospective study from Southern China
verfasst von
Minxi Lao
Mingcheng Huang
Chen Li
Hao Li
Qian Qiu
Zhongping Zhan
Dongying Chen
Publikationsdatum
02.10.2019
Verlag
Springer London
Erschienen in
Clinical Rheumatology / Ausgabe 2/2020
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-019-04779-9

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