Association of chronic nasal carriage of Staphylococcus aureus and higher relapse rates in Wegener granulomatosis.
OBJECTIVE
To examine possible risk factors for relapse, including chronic nasal carriage of Staphylococcus aureus and serial antineutrophil cytoplasmic antibody (ANCA) determinations in patients with Wegener granulomatosis.


METHODS
Observational cohort study.


METHODS
Outpatient clinic at a university-affiliated hospital.


METHODS
Consecutive patients (n = 71) with biopsy-proven Wegener granulomatosis who were seen during follow-up at the outpatient clinic from January 1988 to July 1991. Fourteen patients were ineligible or dropped out; 57 patients were analyzed.


METHODS
Serial ANCA determinations and swab cultures of both anterior nares for S. aureus taken at each visit every 4 to 6 weeks. Occurrence of infections and relapses of Wegener granulomatosis were identified according to strict, predefined criteria.


RESULTS
Thirty-six of the 57 patients (63%; 95% CI, 49% to 76%) were found to be chronic nasal carriers of S. aureus (> or = 75% of nasal cultures positive for S. aureus). Proportional-hazards regression analysis identified chronic nasal carriage of S. aureus (adjusted relative risk, 7.16; CI, 1.63 to 31.50), creatinine clearance above 60 mL.min-1 (adjusted relative risk, 2.94; CI, 1.27 to 6.67), and a history of previous relapses of Wegener granulomatosis (adjusted relative risk, 1.33; CI, 0.98 to 1.78) as independent risk factors for relapse. Twenty-two of 33 patients persistently or intermittently positive for ANCA had a relapse as opposed to only 1 of 21 persistently negative patients. Relapses of Wegener granulomatosis were not related to diagnosed infections.


CONCLUSIONS
Chronic nasal carriage of S. aureus identifies a subgroup of patients with Wegener granulomatosis who are more prone to relapses of the disease, suggesting a role for S. aureus in its pathophysiology and a possible clue for treatment.
Stegeman
C A
CA
University Hospital Groningen, The Netherlands.
Tervaert
J W
JW
Sluiter
W J
WJ
Manson
W L
WL
de Jong
P E
PE
Kallenberg
C G
CG
D000328:Adult; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002353:Carrier State; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications* / Q000276:immunology
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D015415:Biomarkers