Clinical epidemiology of patients with blood stream infection in a nationwide institution of Rheumatology in Japan
Methods: This study design was a retrospective chart review. Tokyo Women’s Medical University (TWMU) Institute of Rheumatology (IOR) is one of the largest institute with rheumatoid arthritis (RA) in Japan, and more than 6000 patients per year admitted to our institute. All episodes of positive blood culture in adult patients who visit or admit to IOR, 18 years of age or older, were evaluated from April 2010 to January 2014. Information on the patient’s age, sex, underlying disease (RA or non-RA), immunosuppressive agents used, dose of steroid, persistent bacteremia, clinical outcomes and newly ascertained underlying diseases were collected. One set of positive blood culture yielding Coagulase-Negative Staphylococci, Bacillus sp. were defined as contamination. Persistent bacteremia was defined as at least two positive blood cultures for same organism obtained on different calendar days. Data were compared using Wilcoxon’s rank test or Fisher’s exact test in appropriate. The p value<0.05 was considered statistical significant. Statistical analyses were performed JMP ver.11 for Mac OS X.
Results: During study period, 1064 sets of blood culture were performed. 78(7.3%) sets of blood culture from 47 patients (RA group; n=19, non-RA group; n=28) were enrolled. The most frequently yield organism was E.coli (38％） in Gram-negative rods (GNR), S.aureus (38％） in Gram-positive cocci (GPC). The mean age was 65 (26-85) years old. In uniivariate analysis, no significant differences were found in mortality rate in 30 days, use of immunosuppressive agents, prophylactic oral TMP-SMX. However patients with persistent bacteremia was tend to be higher in non-RA group (15.8% in RA group and 43.5% in non-RA group, p=0.09).
Conclusion: To our knowledge, this is the first English report of clinical epidemiology of blood culture among patients with autoimmune diseases including RA. Our results suggests that Non-RA patients may develop complication (i.e. abscess) due to persistent bacteremia. Further investigation with sufficient number of cases is needed.
S. Asahata, None
Y. Ainoda, None
T. Fujita, None
K. Totsuka, None
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