PreprintArticleVersion 1This version is not peer-reviewed
The Incidence, Aetiology and Clinical Course of Serious Infections Complicating Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drug Therapy in Patients with Rheumatoid Arthritis in Tropical Australia
Version 1
: Received: 28 September 2024 / Approved: 30 September 2024 / Online: 1 October 2024 (08:06:38 CEST)
How to cite:
Price, C.; Wood, J. P.; Ismail, I.; Smith, S.; Hanson, J. The Incidence, Aetiology and Clinical Course of Serious Infections Complicating Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drug Therapy in Patients with Rheumatoid Arthritis in Tropical Australia. Preprints2024, 2024092430. https://doi.org/10.20944/preprints202409.2430.v1
Price, C.; Wood, J. P.; Ismail, I.; Smith, S.; Hanson, J. The Incidence, Aetiology and Clinical Course of Serious Infections Complicating Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drug Therapy in Patients with Rheumatoid Arthritis in Tropical Australia. Preprints 2024, 2024092430. https://doi.org/10.20944/preprints202409.2430.v1
Price, C.; Wood, J. P.; Ismail, I.; Smith, S.; Hanson, J. The Incidence, Aetiology and Clinical Course of Serious Infections Complicating Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drug Therapy in Patients with Rheumatoid Arthritis in Tropical Australia. Preprints2024, 2024092430. https://doi.org/10.20944/preprints202409.2430.v1
APA Style
Price, C., Wood, J. P., Ismail, I., Smith, S., & Hanson, J. (2024). The Incidence, Aetiology and Clinical Course of Serious Infections Complicating Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drug Therapy in Patients with Rheumatoid Arthritis in Tropical Australia. Preprints. https://doi.org/10.20944/preprints202409.2430.v1
Chicago/Turabian Style
Price, C., Simon Smith and Josh Hanson. 2024 "The Incidence, Aetiology and Clinical Course of Serious Infections Complicating Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drug Therapy in Patients with Rheumatoid Arthritis in Tropical Australia" Preprints. https://doi.org/10.20944/preprints202409.2430.v1
Abstract
Introduction: Patients receiving biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) for rheumatological conditions are at an increased risk of serious, potentially life-threatening, infection. However, the incidence, aetiology and clinical course of serious infection in patients receiving b/tsDMARDs in tropical settings are incompletely defined.
Methods: We retrospectively reviewed all patients with rheumatoid arthritis receiving b/tsDMARDs between October 2012 and October 2021, at Cairns Hospital in tropical Australia. The incidence, aetiology, and clinical course of serious infections (those requiring admission to hospital or parenteral antibiotics) was determined.
Results: 310 patients had 1468 patient-years of b/tsDMARD therapy during the study period; 74/310 (24%) had 147 serious infections translating to an overall risk of 10.0 episodes of serious infection per 100-patient-years. The respiratory tract (50/147, 34%) and skin (37/147, 25%) were the most frequently affected sites. A pathogen was identified in 59/147 (40%) episodes and was most commonly Staphylococcus aureus (24/147, 16%). Only 2/147 (1%) were confirmed “tropical infections”: 1 case of Burkholderia pseudomallei and 1 case of mixed B. pseudomallei and community-acquired Acinetobacter baumannii infection. Overall, 13/147 (9%) episodes of serious infection required Intensive Care Unit admission (0.9 per 100-patient-years of b/tsDMARD therapy) and 4/147 (3%) died from their infection (0.3 per 100-patient-years of b/tsDMARD therapy). The burden of comorbidity and co-administration of prednisone were the strongest predictors of death or a requirement for ICU admission.
Conclusion: The risk of serious infection in patients taking b/tsDMARDs in tropical Australia is higher than in temperate settings, but this is not explained by an increased incidence of traditional tropical pathogens.
Keywords
Infectious diseases; Immunosuppression; Tropical medicine; Rheumatoid arthritis; Aboriginal and Torres Strait Islander peoples; Tropical Australia
Subject
Medicine and Pharmacology, Tropical Medicine
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
