TY - JOUR
T1 - Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis
T2 - results from a longitudinal, matched-cohort data linkage study
AU - Sarica, Shifa H
AU - Dhaun, Neeraj
AU - Sznajd, Jan
AU - Harvie, John
AU - McLaren, John
AU - McGeoch, Lucy
AU - Kumar, Vinod
AU - Amft, Nicole
AU - Erwig, Lars
AU - Marks, Angharad
AU - Black, Corri
AU - Basu, Neil
N1 - We wish to thank Information Division Services Scotland for assisting with data linkage and data access in the National Safe Haven. Information presented in this article was previously presented as a poster at the American College of Rheumatology Annual Conference 2018, Chicago, IL, USA. The study was conceived by S.H.S., A.M., C.B. and N.B. All authors contributed to the study design and data collection. Data analysis and interpretation and drafting of the manuscript were conducted by all authors. C.B. and N.B. were joint senior authors. All authors critically reviewed the manuscript and approved the final version.
Funding: S.H.S. and the study were funded by the Aberdeen Development Trust and the Farr Institute of Health Informatics Research. The Farr Institute is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates) and the Wellcome Trust (Scotland MR/K007017/1).
Disclosure statement: L.E. is a GlaxoSmithKline employee. The other authors have declared no conflicts of interest.
PY - 2020/10
Y1 - 2020/10
N2 - 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.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.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)].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.
AB - 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.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.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)].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.
KW - eosinophilic granulomatosis with polyangiitis
KW - microscopic polyangitis
KW - Infections
KW - Longitudal study
KW - granulomatosis with polyangiitis
KW - eosinophilic granulomatosis with polyangiitis
KW - microscopic polyangiitis
KW - infections
KW - longitudinal study
UR - http://www.scopus.com/inward/record.url?scp=85091691687&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/keaa070
DO - 10.1093/rheumatology/keaa070
M3 - Article
C2 - 32159801
VL - 59
SP - 3014
EP - 3022
JO - Rheumatology
JF - Rheumatology
SN - 1462-0324
IS - 10
ER -
