PMID- 31723485
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 11
IP  - 9
DP  - 2019 Sep 16
TI  - Relationship Between Immunosuppressive Therapy and the Development of Infectious 
      Complications Among Patients with Anti-neutrophil Cytoplasmic Antibody-associated 
      Vasculitis: A Single-center, Retrospective Observational Study.
PG  - e5676
LID - 10.7759/cureus.5676 [doi]
LID - e5676
AB  - Introduction Infectious complications are the leading cause of death in patients 
      with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). However, 
      the relationship between initial immunosuppressive therapy and the development of 
      infectious complications and the details of infectious complications among 
      patients with AAV are uncertain. We thus aimed to determine the association 
      between initial immunosuppressive therapy and infectious complications. Material 
      and methods Forty-seven patients with newly diagnosed AAV were enrolled in this 
      retrospective observational study (patients with eosinophilic granulomatous 
      polyangiitis were excluded). We statistically determined the association between 
      types of initial immunosuppressive therapy (methylprednisolone pulse and/or 
      cyclophosphamide therapy) and the development of infectious complications. In 
      addition, we investigated the causes and timing of the onset of infectious 
      complications. Results Twenty-one (21; 44.7%) patients required antibiotic, 
      antimycotic, or antiviral therapy because of the development of infectious 
      complications. Multiple logistic regression analyses adjusted for age and sex 
      revealed that methylprednisolone pulse and cyclophosphamide therapy were 
      significantly associated with the development of infectious complications (odds 
      ratio (OR) 4.85, 95% confidence interval (CI) 1.09-21.5, p = 0.038; OR 5.32, 95% 
      CI 1.28-22.2, p = 0.022, respectively). Bacterial pneumonia and sepsis occurred 
      in 10 (47.6%) and 6 (28.6%) patients, respectively. Almost half of these 
      infectious complications, including fungal infection, developed within six months 
      from the start of initial treatment. Conclusion Among patients with AAV, 
      methylprednisolone pulse and cyclophosphamide therapy may increase the risk of 
      developing infectious complications, such as pneumonia and sepsis, including 
      fungal infection, particularly within six months from the initiation of 
      treatment.
CI  - Copyright (c) 2019, Harada et al.
FAU - Harada, Makoto
AU  - Harada M
AD  - Department of Nephrology, Shinshu University, Matsumoto, JPN.
FAU - Ishii, Wataru
AU  - Ishii W
AD  - Department of Rheumatology, Nagano Red Cross Hospital, Nagano, JPN.
FAU - Masubuchi, Takeshi
AU  - Masubuchi T
AD  - Department of Respiratory Medicine, Nagano Red Cross Hospital, Nagano, JPN.
FAU - Ichikawa, Tohru
AU  - Ichikawa T
AD  - Department of Nephrology, Nagano Red Cross Hospital, Nagano, JPN.
FAU - Kobayashi, Mamoru
AU  - Kobayashi M
AD  - Department of Nephrology, Nagano Red Cross Hospital, Nagano, JPN.
LA  - eng
PT  - Journal Article
DEP - 20190916
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC6825464
OTO - NOTNLM
OT  - anti-neutrophil cytoplasmic antibody-associated vasculitis
OT  - cyclophosphamide
OT  - infection
OT  - methylprednisolone pulse
COIS- The authors have declared that no competing interests exist.
EDAT- 2019/11/15 06:00
MHDA- 2019/11/15 06:01
PMCR- 2019/09/16
CRDT- 2019/11/15 06:00
PHST- 2019/11/15 06:00 [entrez]
PHST- 2019/11/15 06:00 [pubmed]
PHST- 2019/11/15 06:01 [medline]
PHST- 2019/09/16 00:00 [pmc-release]
AID - 10.7759/cureus.5676 [doi]
PST - epublish
SO  - Cureus. 2019 Sep 16;11(9):e5676. doi: 10.7759/cureus.5676.