PMID- 31349802
OWN - NLM
STAT- MEDLINE
DCOM- 20191007
LR  - 20211204
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 19
IP  - 1
DP  - 2019 Jul 26
TI  - Oral candidiasis is a significant predictor of subsequent severe infections 
      during immunosuppressive therapy in anti-neutrophil cytoplasmic 
      antibody-associated vasculitis.
PG  - 664
LID - 10.1186/s12879-019-4300-0 [doi]
LID - 664
AB  - BACKGROUND: Several studies have identified predictors of severe infections in 
      antineutrophil cytoplasmic antibody-associated vasculitis (AAV). However, the 
      development of oral candidiasis (OC) as a predictor of subsequent severe 
      infections has not been evaluated. The aim of this study was to assess the 
      association between OC and subsequent severe infection requiring hospitalization 
      during immunosuppressive therapy in AAV. METHODS: This single-center 
      retrospective cohort study included 71 consecutive patients with newly diagnosed 
      AAV from Aichi Medical University Hospital, Japan, starting immunosuppressive 
      therapy between March 2013 and December 2018. The relationships between OC and 
      subsequent severe infections were assessed using multivariate Cox proportional 
      hazards models, adjusted for clinically relevant factors. RESULTS: During the 
      follow-up period (median, 23 months; interquartile range, 11-51 months), 25 
      severe infectious episodes occurred in 19 patients (26.8%) and OC occurred in 17 
      patients (23.9%). A log-rank test showed that the OC group was significantly 
      associated with severe infection (P <  0.001). Multivariate Cox proportional 
      hazards models identified lower serum albumin (per 1 g/dl adjusted hazard ratio 
      (HR)  = 0.38, 95% confidence interval (CI): 0.15-0.85; P  =  0.018), use of 
      methylprednisolone pulse (adjusted HR  =  5.44, 95% CI: 1.54-20.0; P  =  0.010), 
      and OC (adjusted HR  = 5.31, 95% CI: 1.86-15.8; P  =  0.002) as significant 
      predictors of severe infection. Furthermore, a significant effect modification of 
      the use of methylprednisolone pulse on OC was observed (P <  0.001). CONCLUSIONS: 
      OC is one of the predictors of subsequent severe infections. The results suggest 
      the importance of prolonging infection surveillance, especially for patients who 
      developed OC under strong immunosuppressive therapy.
FAU - Yamaguchi, Makoto
AU  - Yamaguchi M
AD  - Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 
      Karimata, Yazako, Nagakute, 480-1195, Japan.
FAU - Katsuno, Takayuki
AU  - Katsuno T
AD  - Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 
      Karimata, Yazako, Nagakute, 480-1195, Japan.
FAU - Iwagaitsu, Shiho
AU  - Iwagaitsu S
AD  - Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 
      Karimata, Yazako, Nagakute, 480-1195, Japan.
FAU - Nobata, Hironobu
AU  - Nobata H
AD  - Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 
      Karimata, Yazako, Nagakute, 480-1195, Japan.
FAU - Kinashi, Hiroshi
AU  - Kinashi H
AD  - Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 
      Karimata, Yazako, Nagakute, 480-1195, Japan.
FAU - Banno, Shogo
AU  - Banno S
AD  - Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 
      Karimata, Yazako, Nagakute, 480-1195, Japan.
FAU - Ito, Yasuhiko
AU  - Ito Y
AD  - Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 
      Karimata, Yazako, Nagakute, 480-1195, Japan. yasuito@aichi-med-u.ac.jp.
LA  - eng
PT  - Journal Article
DEP - 20190726
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Aged
MH  - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug 
      therapy/immunology
MH  - Candidiasis, Oral/*etiology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Immunosuppression Therapy
MH  - Immunosuppressive Agents/administration & dosage/*adverse effects
MH  - Japan
MH  - Male
MH  - Proportional Hazards Models
MH  - Retrospective Studies
PMC - PMC6660661
OTO - NOTNLM
OT  - AAV
OT  - ANCA
OT  - Antineutrophil cytoplasmic antibody
OT  - Infection
OT  - Oral candidiasis
OT  - Small-vessel vasculitis
COIS- The authors declare that they have no competing interests.
EDAT- 2019/07/28 06:00
MHDA- 2019/10/08 06:00
PMCR- 2019/07/26
CRDT- 2019/07/28 06:00
PHST- 2019/05/16 00:00 [received]
PHST- 2019/07/18 00:00 [accepted]
PHST- 2019/07/28 06:00 [entrez]
PHST- 2019/07/28 06:00 [pubmed]
PHST- 2019/10/08 06:00 [medline]
PHST- 2019/07/26 00:00 [pmc-release]
AID - 10.1186/s12879-019-4300-0 [pii]
AID - 4300 [pii]
AID - 10.1186/s12879-019-4300-0 [doi]
PST - epublish
SO  - BMC Infect Dis. 2019 Jul 26;19(1):664. doi: 10.1186/s12879-019-4300-0.