RT Journal Article
T1 Impact of Immunosuppressive Agents on Clinical Manifestations and Outcome of Staphylococcus aureus Bloodstream Infection: A Propensity Score-Matched Analysis in 2 Large, Prospectively Evaluated Cohorts.
A1 Camp, Johannes
A1 Glaubitz, Lina
A1 Filla, Tim
A1 Kaasch, Achim J
A1 Fuchs, Frieder
A1 Scarborough, Matt
A1 Kim, Hong Bin
A1 Tilley, Robert
A1 Liao, Chun-Hsing
A1 Edgeworth, Jonathan
A1 Nsutebu, Emmanuel
A1 López-Cortés, Luis Eduardo
A1 Morata, Laura
A1 Llewelyn, Martin
A1 Fowler, Vance G
A1 Thwaites, Guy
A1 Seifert, Harald
A1 Kern, Winfried V
A1 Kuss, Oliver
A1 Rieg, Siegbert
K1 bacteremia
K1 complications
K1 corticosteroids
K1 dissemination
K1 immunosuppression
AB Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection. The impact of immunosuppressive agents on the outcome of patients with SAB is incompletely understood. Data from 2 large prospective, international, multicenter cohort studies (Invasive Staphylococcus aureus Infections Cohort [INSTINCT] and International Staphylococcus aureus Collaboration [ISAC]) between 2006 and 2015 were analyzed. Patients receiving immunosuppressive agents were identified and a 1:1 propensity score-matched analysis was performed to adjust for baseline characteristics of patients. Overall survival and time to SAB-related late complications (SAB relapse, infective endocarditis, osteomyelitis, or other deep-seated manifestations) were analyzed by Cox regression and competing risk analyses, respectively. This approach was then repeated for specific immunosuppressive agents (corticosteroid monotherapy and immunosuppressive agents other than steroids [IMOTS]). Of 3188 analyzed patients, 309 were receiving immunosuppressive treatment according to our definitions and were matched to 309 nonimmunosuppressed patients. After propensity score matching, baseline characteristics were well balanced. In the Cox regression analysis, we observed no significant difference in survival between the 2 groups (death during follow-up: 105/309 [33.9%] immunosuppressed vs 94/309 [30.4%] nonimmunosuppressed; hazard ratio [HR], 1.20 [95% confidence interval {CI}, .84-1.71]). Competing risk analysis showed a cause-specific HR of 1.81 (95% CI, .85-3.87) for SAB-related late complications in patients receiving immunosuppressive agents. The cause-specific HR was higher in patients taking IMOTS (3.69 [95% CI, 1.41-9.68]). Immunosuppressive agents were not associated with an overall higher mortality. The risk for SAB-related late complications in patients receiving specific immunosuppressive agents such as IMOTS warrants further investigations.
YR 2021
FD 2021
LK https://hdl.handle.net/10668/27634
UL https://hdl.handle.net/10668/27634
LA en
DS RISalud
RD Apr 6, 2025