Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, matched-cohort data linkage study

Shifa H. Sarica, Neeraj Dhaun, Jan Sznajd, John Harvie, John McLaren, Lucy McGeoch, Vinod Kumar, Nicole Amft, Lars Erwig, Angharad Marks, Corri Black, Neil Basu (Lead / Corresponding author)

    Research output: Contribution to journalArticlepeer-review

    20 Downloads (Pure)

    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.

    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.

    Original languageEnglish
    Pages (from-to)3014-3022
    Number of pages9
    JournalRheumatology
    Volume59
    Issue number10
    Early online date11 Mar 2020
    DOIs
    Publication statusPublished - Oct 2020

    Keywords

    • granulomatosis with polyangiitis
    • eosinophilic granulomatosis with polyangiitis
    • microscopic polyangiitis
    • infections
    • longitudinal study

    Fingerprint Dive into the research topics of 'Characterizing infection in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, matched-cohort data linkage study'. Together they form a unique fingerprint.

    Cite this