Staphylococcus aureus bacteremia in patients with rheumatoid arthritis - Data from the prospective INSTINCT cohort.
Patients with rheumatoid arthritis (RA) are considered to be at increased risk of severe infections. We here describe the clinical characteristics, course and outcome of RA patients with Staphylococcus aureus bacteremia (SAB).



We conducted a post hoc analysis of data from a German bi-center prospective SAB cohort study (period 2006-2014). Patients were followed-up for one year. Primary and secondary outcomes were survival time and osteoarticular infection (OAI).



A total of 1069 patients with SAB were analyzed, with 31 patients suffering from RA. RA patients showed significantly more often OAI (15/31 patients, 48% vs. 152/1038, 15%), disseminated infection (12/31, 39% vs. 164/1038, 16%) and severe sepsis/septic shock (12/31, 39% vs. 235/1038, 23%). Day-30 mortality in RA patients was 36% (vs. 19% in non-RA patients, p = 0.034), and day 90 mortality was 58% (vs. 32%, p = 0.003). Multivariate analyses confirmed RA to be an independent risk factor for death (HR 2.3, 95% CI 1.4-3.7) and OAI (OR 4.2, 95% CI 1.8-9.8).



Patients with RA exhibit a complicated SAB course and a high mortality, their management is challenging. Adequate antibiotic treatment, prompt invasive diagnostic and therapeutic procedures like joint lavage or surgery are of pivotal importance. Joint damage due to RA may confer a higher risk of acquiring OAI than immunosuppression.
Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany. Electronic address: insa.joost@uniklinik-freiburg.de.
Insa
I
Joost
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19, 50937, Cologne, Germany.
Achim
A
Kaasch
Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany.
Christine
C
Pausch
Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany.
Gabriele
G
Peyerl-Hoffmann
Institute of Microbiology and Hygiene, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany.
Christian
C
Schneider
Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
Reinhard E
RE
Voll
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19, 50937, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany.
Harald
H
Seifert
Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany.
Winfried V
WV
Kern
Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany; Center for Chronic Immunodeficiency, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany. Electronic address: Siegbert.rieg@uniklinik-freiburg.de.
Siegbert
S
Rieg
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents
Bloodstream infection; Bone and joint infections; Complicated bacteremia; Hematogenous dissemination; Immunosuppressive treatment; Osteoarticular infection