title: Bloodstream infections among children with juvenile idiopathic arthritis: a prospective study from the onset of disease.
abstract: OBJECTIVE
  To describe the incidence and nature of bloodstream infections (BSI) among children with juvenile idiopathic arthritis (JIA) followed-up prospectively from disease onset.
  
  
  METHODS
  The Social Insurance Institution's (SII) national register on individuals with reimbursement for medication of chronic diseases was used to identify children with JIA from 2004 through 2011 and their medications. The National Infectious Disease Register (NIDR) collects data of all blood culture positive samples from all microbiology laboratories in Finland. We combined the NIDR and SII registers to identify JIA patients with BSI. Clinical and laboratory data of each JIA-BSI patient were collected from hospital records.
  
  
  RESULTS
  There were 1604 JIA patients and 6630 person-years of follow-up. Five patients had BSI. During the first 5 years after diagnosis the cumulative emergence of BSI was 0.38% [95% confidence interval (CI) 0.16% to 0.92%]. The incidence rates were 7.5/10 000 follow-up years for JIA (95% CI 2.4-17.6) and 2.8/10 000 follow-up years for the age-matched general population (95% CI 2.7-2.9). The standardised incidence ratio was 3.0 (95% CI 1.2 to 7.2). The causative bacteria were Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli and Fusobacterium necrophorum. Three patients were on anti-rheumatic drugs, including two on TNF inhibitors. All patients responded rapidly to antimicrobial therapy and recovered uneventfully.
  
  
  CONCLUSIONS
  Although BSI is rare among children with JIA, the incidence is 3-fold higher than among the general population.
authors.affiliation: Regional Centre Oiva, Hollola, Finland and Department of Pediatrics, University of Helsinki, Helsinki, Finland. paivi.salonen@oivappk.fi.
authors.forename: Päivi H
authors.initials: PH
authors.lastname: Salonen
authors.forename: Hanna
authors.initials: H
authors.lastname: Säilä
authors.forename: Juha H
authors.initials: JH
authors.lastname: Salonen
authors.forename: Marjo
authors.initials: M
authors.lastname: Vuorela
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Outi
authors.initials: O
authors.lastname: Lyytikäinen
authors.forename: Markku J
authors.initials: MJ
authors.lastname: Kauppi
authors.forename: Marjatta
authors.initials: M
authors.lastname: Leirisalo-Repo
authors.forename: Heikki
authors.initials: H
authors.lastname: Repo
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002675:Child, Preschool; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D045825:Fusobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents