K-3398. A Nationwide Study of Bacteremia Complicating Tumor Necrosis Factor-Alpha Antagonists Therapy
Session: Poster Session: Blood Stream Infections
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: Pts treated with TNF-α antagonists have an increased susceptibility to opportunistic infections. Few data on pyogenic bacteremia and its outcome are currently available. Methods: RATIO is a French multidisciplinary group collecting data on severe infections occurring in pts receiving TNF-α inhibitors. All cases were validated by ID specialists. Results: 40 pts receiving TNF-α inhibitors (rheumatoid arthritis (31), ankylosing spondylarthritis (4), psoriasis (3), polyarteritis nodosa (1) and Crohn’s disease (1)) developed bacteremia during the 2004-2006 period. Median age was 61 yrs (range, 25-84), M/F ratio was 1/3. 15 pts received etanercept, 14 infliximab and 11 adalimumab. Median duration of TNF-α antagonist treatment at onset of infection was 53 wks (range, 1-264); 34 pts had concomitant steroids and 14 methotrexate; 12 pts presented comorbidities (7 diabetes mellitus, 3 Sjögren’s disease, 2 chronic bronchopathy). Infection entry site remained unknown in 25%. Associated sites of infection were joints (32.5%), urinary tract (23%) and lungs (7.5%). Causative bacteria were Staphylococcus aureus (47.5%; 95% susceptible to methicillin), Escherichia coli (30%), and Streptococcus spp. (15%). TNF-α antagonist therapy was stopped in 57.5% of the cases. 6 were admitted to ICU and death occurred in 5 pts (12.5%). Conclusions: Bacteremia is a potentially lethal infection complicating anti-TNF-α therapy mostly caused by susceptible Staphylococcus aureus ; anti-staphylococcal therapy is thus mandatory for the first line management of sepsis in these pts.
Christian Michelet, MD, PhD1, Dominique Salmon, MD, PhD2, Florence Tubach, MD3, M Lemann4, Olivier Lortholary, MD, PhD2, Patricia Ravaud2, Pierre Dellamonica, MD, PhD5, Pierre Loulergue6, ROSE Chichmanian7, Xavier Mariette, MD, PhD4 and  P. Loulergue, None., (1)Pontchaillou University Hospital, Rennes, France, (2)AP-HP; Univ. Paris V, (3)UnitÚ de Recherche Clinique, H˘pital Bichat, (4)AP-HP; Univ. Paris Sud, (5)Univ. Nice, (6)AP-HP; Univ. Paris V, Paris, France, (7)AFSSAPS


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