title: Risk Factors for Targeted Fungal and Mycobacterial Infections in Patients Taking Tumor Necrosis Factor Inhibitors.
abstract: OBJECTIVE
  To identify predictors of the receipt of medical care, including the receipt of pre-drug screening, for diagnostically targeted fungal or mycobacterial infections among patients prescribed a tumor necrosis factor inhibitor (TNFi).
  
  
  METHODS
  We conducted a case-control study using deidentified patient health claims information from a data set representing a commercially insured US population of 15 million patients annually from January 1, 2007 to December 31, 2009. Descriptive statistics as well as a 2-sample t-test, chi-square test of association, Fisher's exact test, and multivariate logistic regression were used for data analysis.
  
  
  RESULTS
  A total of 30,772 patients received a TNFi during the study period. Of these, 158 patients (0.51%) developed targeted fungal and/or mycobacterial infections (cases). The median number of infections per case was 1.0 (interquartile range 1.0-2.0). Tuberculosis was diagnosed in 61% of cases, followed by histoplasmosis in 60%, nontuberculous mycobacterial infections in 11%, coccidioidomycosis in 10%, unspecified fungal infection in 8%, blastomycosis in 4%, cryptococcal infection in 3%, and pneumocystosis in 2%. Compared to controls (n = 474), a higher proportion of cases were prescribed prednisone (55% versus 37%; P < 0.001). Patients who were prescribed prednisone during the study period were twice as likely as those not taking prednisone to seek medical care attributable to a targeted fungal or mycobacterial infection (odds ratio 2.03; P < 0.001).
  
  
  CONCLUSIONS
  Development of a targeted fungal or mycobacterial infection among patients taking a TNFi is rare. Concomitant use of prednisone predicted development of such infections.
authors.affiliation: University of Kentucky, Lexington.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Salt
authors.affiliation: University of Kentucky, Lexington.
authors.forename: Amanda T
authors.initials: AT
authors.lastname: Wiggins
authors.affiliation: University of Kentucky, Lexington.
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Rayens
authors.affiliation: University of Kentucky, Lexington.
authors.forename: Moises A
authors.initials: MA
authors.lastname: Huaman
authors.affiliation: University of Kentucky, Lexington.
authors.forename: David
authors.initials: D
authors.lastname: Mannino
authors.affiliation: University of Kentucky, Lexington.
authors.forename: Philip
authors.initials: P
authors.lastname: Schwieterman
authors.affiliation: Lexington Clinic, Lexington, Kentucky.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Merkley
authors.affiliation: University of Kentucky, Lexington.
authors.forename: Allison R
authors.initials: AR
authors.lastname: Jones
authors.affiliation: Vanderbilt University, Nashville, Tennessee.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Crofford
mesh_terms: D001759:Blastomycosis / Q000209:etiology; D016022:Case-Control Studies; D003047:Coccidioidomycosis / Q000209:etiology; D003453:Cryptococcosis / Q000209:etiology; D005260:Female; D006660:Histoplasmosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000209:etiology*; D009181:Mycoses / Q000209:etiology*; D011020:Pneumonia, Pneumocystis / Q000209:etiology; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D014376:Tuberculosis / Q000209:etiology; D000079424:Tumor Necrosis Factor Inhibitors
chemical_list: D000079424:Tumor Necrosis Factor Inhibitors; D011241:Prednisone