Risk of opportunistic infections in patients with antineutrophil cytoplasmic antibody‐associated vasculitis, using a Japanese health insurance database

Sakai, Ryoko; Tanaka, Eiichi; Nishina, Hirokazu; Suzuki, Masayoshi; Yamanaka, Hisashi; Harigai, Masayoshi

doi:10.1111/1756-185x.13662

Cited by 17 publications

(15 citation statements)

References 27 publications

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“…5 Population-based studies are less prone to selection bias and allow long-term follow-up of relatively rare conditions and can thus enhance our limited understanding of OI in lupus. 3,7,12,13 Based on the above, we performed a population-wide long-term study into the rate and changes over time for overall and organism specific hospital admission for OI among lupus patients in Western Australia (WA) during a period (1985–2015) where more intensive and targeted immunomodulation for lupus gradually became embedded in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Temporal trends in hospitalisation for opportunistic infections in lupus patients in Western Australia

Nossent

Keen

Preen

et al. 2022

Lupus

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Background Lupus patients often require aggressive immunosuppressive therapy, which increases the risk for infections. We studied the temporal rates for opportunistic infections (OI) and associated mortality in lupus patients hospitalised in Western Australia. Methods All patients hospitalized in the period 1985–2015 with ≥2 ICD based diagnostic codes for SLE were included. OI was defined as a microbiologically confirmed mycobacterial, fungal, or viral infection. Descriptive data are given as median (IQR) and frequency (%) with incidence rates (IR) calculated per 1000 person years and IR trend rates analysed across 10-year periods by least square regression (R2). Results The study cohort (n = 1408) contained 85.3% females with age at entry 35 years (IQR 22–51). During median follow-up of 21.1 years (IQR 17.5–29.6) hospitalisation for OI occurred in 121 (8.6%) patients with recurrent or multiple OI observed in 42 (34.7%) patients. During 29.771 thousand person years, a total of 295 OI were diagnosed for an overall IR rate of 9.91 (CI 8.82–11.09)/1000 person years which did not decrease significantly over time (R2 0.14). Significant decreases were however seen in the IR for tuberculosis (R2 0.88), cryptococcal (R2 0.98) and pneumocystis (R2 0.98) infections, with increasing IR observed for other mycobacteria (R2 0.99) and aspergillosis (R2 0.55) and little change seen for H Zoster (R2 0.18) and Varicella (R2 0.10) infections. In-hospital death during OI admission occurred in 9/121 patients (7.4%). There was no significant gender difference in IR or outcome of OI. Conclusions Hospitalization rates for OI in lupus patients have not changed significantly over time, but there has been a clear shift in the underlying OI. The decrease in mycobacterial and pneumocystis infections suggest successful prophylaxis but the increase in viral and mycotic infections indicate a sustained need to improve prevention of these OI in lupus patients.

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Section: Introductionmentioning

confidence: 99%

Temporal trends in hospitalisation for opportunistic infections in lupus patients in Western Australia

Nossent

Keen

Preen

et al. 2022

Lupus

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“…Prednisolone use was identified as a risk factor for CMV infection. 47,49 In their multivariate analysis, Sakai et al 49 underlying rheumatic disease (P < 0.01). They also found that their patients with symptomatic CMV infection received higher average prednisolone doses compared with their non-symptomatic counterparts (median 32, range 4-100 mg/day vs. median 20, range 1-50 mg/day, P < 0.01).…”

Section: Treatmentmentioning

confidence: 99%

“…Patient demographics Age (for any opportunistic infection) 49 Male 47 Laboratory characteristics Lymphopenia or decreases in lymphocyte count over 4 weeks 47,48 Albumin <30 g/L or decreases in albumin over 4 weeks 48 Lower CD4 + T-cell count 47 Higher LDH, BUN levels 47…”

Section: Significant Risk Factors For CMV Infection In Patients With ...mentioning

confidence: 99%

Factors associated with cytomegalovirus infection in antineutrophil cytoplasmic antibody‐associated vasculitis: A narrative review

Leong

Fong

2022

Int J of Rheum Dis

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Patients with antineutrophil cytoplasmic antibody‐associated vasculitis (AAV) are vulnerable to opportunistic infections, including cytomegalovirus (CMV) infection. This narrative review aims to identify factors associated with CMV infection in patients with AAV. The literature review was conducted on Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, PubMed, Scopus, and Web of Science. The start date of the literature search was unrestricted and the end date was February 2022. CMV infection was defined as (a) CMV pp65 antigenemia or positive CMV DNA viral load by polymerase chain reaction or CMV detection on histological specimens, with associated signs and symptoms compatible with CMV infection; (b) presence of CMV clinical syndrome (defined as presence of compatible symptoms and signs and documentation of CMV by biopsy by virus isolation, rapid culture, immunohistochemistry, or DNA in biopsy material as defined by the CMV Drug Development Forum); and (c) CMV infection as coded by the International Statistical Classification of Diseases and Related Health Problems, 10th revision with at least one prescription for CMV treatment. We identified 4505 articles, of which three (2327 patients with AAV) were included. All studies were retrospective and only one of the three studies included only patients with AAV. Low or decreasing lymphocyte counts and higher prednisolone usage were associated with CMV infection in patients with AAV. Patients with AAV with lymphopenia and on high doses of prednisolone should be monitored closely for signs and symptoms of CMV infection, and might benefit from CMV prophylaxis. Prospective studies are urgently needed to better identify causes of CMV infections in patients with AAV.

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“… 5 In France, dexamethasone is now the standard of care in patients hospitalized with moderate to severe COVID‐19 pneumonia associated with excessive systemic inflammation. 6 However, corticosteroids in this context may be associated with delayed viral clearance such as observed in other coronavirus‐induced severe pneumonia, 7 , 8 , 9 increased opportunistic infection, 9 , 10 hyperglycemia 11 and other side effects. Data are still lacking on the precise timing of initiation and practical use of dexamethasone in COVID‐19.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with dexamethasone efficacy in COVID‐19. A retrospective investigative cohort study

Arcani

Cauchois

Suchon

et al. 2022

Journal of Medical Virology

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Dexamethasone has demonstrated efficacy in reducing mortality in COVID‐19. However, its practical use is badly defined. We aimed to investigate factors associated with dexamethasone efficacy in real life. Our retrospective study was conducted in two university hospitals between September and November 2020 and included all the consecutive hospitalized patients with a laboratory‐confirmed SARS‐CoV‐2 infection assessed by RT‐PCR, treated with intravenous dexamethasone (6 mg/day). Among 111 patients, 10.6% necessitated a transfer into the intensive care unit (ICU) and the 28‐day mortality rate was 17.1%. The 28‐day mortality rate was significantly lower in patients who demonstrated improvement at 48 h (hazard ratio [HR]: 0.17, 95% confidence interval [CI]: 0.04–0.78, p = 0.02) and 96 h (HR: 0.07, 95% CI: 0.02–0.31, p = 0.0005) after dexamethasone initiation. Apart from well‐known risk factors (age, hypertension, active cancer, severe lesions on chest computed tomography [CT] scan), we found that a high viral load in nasopharyngeal swab (Cycle threshold <30) at dexamethasone initiation was associated with higher 28‐day mortality (66.6% vs. 36.7%, p = 0.03). Patients who did not receive antibiotics at dexamethasone initiation had a higher rate of transfer into the ICU (55.6% vs. 23.5%, p = 0.045) with a trend towards higher mortality in case of severe or critical lesions on CT scan (75.0% vs. 25.0%, p = 0.053). Patients who did not improve within 2–4 days after steroid initiation have a bad prognosis and should receive additional anti‐inflammatory drugs. Our data suggest better efficacy of dexamethasone in patients with a low or negative viral load, receiving broad‐spectrum antibiotics.

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Risk of opportunistic infections in patients with antineutrophil cytoplasmic antibody‐associated vasculitis, using a Japanese health insurance database

Cited by 17 publications

References 27 publications

Temporal trends in hospitalisation for opportunistic infections in lupus patients in Western Australia

Temporal trends in hospitalisation for opportunistic infections in lupus patients in Western Australia

Factors associated with cytomegalovirus infection in antineutrophil cytoplasmic antibody‐associated vasculitis: A narrative review

Factors associated with dexamethasone efficacy in COVID‐19. A retrospective investigative cohort study

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