Bacteremia in patients receiving TNF-alpha antagonists--a prospective multicenter study.
OBJECTIVE
TNF-alpha antagonists have changed the outcome of various chronic inflammatory diseases. Their use has spread widely and many patients receive those treatments for years. Previous reports found that the use of TNF-alpha antagonists may be associated with an increased risk of serious bacterial infections. We report 47 prospective bacteremia cases from the RATIO registry.


METHODS
A national prospective study was conducted in France between 2004 and 2007 to collect severe bacterial infections in patients receiving TNF-alpha antagonists. All reported cases of bacteremia were validated by an expert committee.


RESULTS
Forty-seven bacteremic episodes were reported. Staphylococcus aureus represented the most frequent causative pathogen (40%) and was mostly associated with bones and/or joints infections (68%) and with a worse outcome compared to that observed with other bacterial pathogens.


CONCLUSIONS
Patients receiving TNF-alpha antagonists may develop bacteremia and S. aureus has to be included in the spectrum of the initial empiric antimicrobial therapy.
Université Paris Descartes, Faculté de médecine, AP-HP, Service de Maladies Infectieuses, hôpital Necker Enfants Malades, Centre d'infectiologie Necker Pasteur, 75015 Paris, France. Electronic address: pierre.loulergue@cch.aphp.fr.
Pierre
P
Loulergue
Florence
F
Tubach
Dominique
D
Salmon
Pierre
P
Dellamonica
Bruno
B
Taillan
Jean-Baptiste
JB
Thorel
Philippe
P
Marteau
Christian
C
Bressot
Philippe
P
Ravaud
Xavier
X
Mariette
Olivier
O
Lortholary
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D016470:Bacteremia / Q000139:chemically induced* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha
AFSSAPS; Bacteremia; INSERM; RATIO; Rheumatoid arthritis; Staphylococcus aureus; TNF; Tumour necrosis factor (TNF)-alpha antagonist; agence française de la sécurité sanitaire des produits de santé; institut national de la recherche médicale; recherche axée sur les biothérapies; tumor necrosis factor