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Clin Exp Rheumatol. 2009 Nov-Dec;27(6):920-5.

Non-typhi Salmonella infection in patients with rheumatic diseases on TNF-alpha antagonist therapy.

Collaborators (160)

Abad MA, Abasolo L, Abreu P, Alcanyis L, Alegre de Miguel C, Alegre J, Almodovar R, Alonso A, Andreu JL, Aragón A, Arasa X, Aznar E, Balsa A, Bañegil I, Barceló M, Batlle E, Belmonte MA, Beltrán Audera J, Beltrán Fabregat J, Blanco J, Bonilla G, Cabero F, Cabezas JA, Calvo J, Campos C, Cano L, Cañete JD, Carmona L, Caro N, Casado E, Castro MC, Cebrian L, Centellas M, Collantes E, Corteguera M, Crespo M, Cruz A, Cuadra JL, Cuende E, Cuesta E, Eliseo V, Erausquin C, Espadaler L, Fernandez Carbadillo C, Fernandez Campillo J, Fernandez Prada M, Fiter J, Freire M, Galindo M, Garcia Aparicio A, Garcia Borras JJ, García Gómez MC, Garcia J, García Meijide JA, Gelman SM, Gimenez Ubeda E, Gómez Centeno E, Gómez Vaquero C, González Fernández MJ, González Gómez ML, González Hernández T, González-Alvaro I, González-Montagut C, Granados I, Grandal Y, Graña J, Gratacos J, Hernández del Río A, Hernández FF, Hernández MV, Ibañez J, Ibero I, Idalgo C, Instxaurbe AR, Irigoyen MV, Ivorra J, Jiménez Palop M, Jimenez Zorzo F, Jovani V, Joven B, Juan Mas A, Juanes A, Judez E, Larrosa M, Linares LF, López Longo FJ, Loza E, Maese J, Maiz O, Manero FJ, Martín R, Martinez Cirstobal A, Marzo J, Mateo I, Maymo J, Mayordomo L, Mazzucheli R, Medrano M, Merino R, Miguez M, Montesinos D, Montoro M, Mora MA, Moreno E, Muñoz L, Naranjo A, Negueroles R, Noguera JR, Ojeda S, Ortiz AM, Ortiz V, Panadero G, Pantoja L, Pecondón A, Peiró E, Pérez Guijo V, Pérez Sandoval T, Pérez-Pampín E, Pérez-Zafrilla B, Pina MF, Quirós J, Ramos López P, Reina D, Rejón E, Rivera J, Rodríguez B, Rodríguez Gómez M, Rodríguez López M, Rodriguez Lozano C, Rosas JC, Roselló R, Rotes I, Rúa I, Ruiz Jimeno MT, Saiz Cuenca E, Sampedro J, Sánchez-Andrade A, Sanmartí R, Santos G, Santos Rey J, Sellas A, Tena X, Tenorio M, Tomero E, Torres MC, Torresano M, Ureña I, Uriarte E, Urruticoechea A, Valdazo JP, Valero JL, Valls M, Valvanera M, Vazquez Galeano C, Vela P, Vesga JC, Villaverde V, Ybañez D, Zarco P, Zubieta J.

Author information

1
Division of Rheumatology, Hospital Universitario Marques de Valdecilla, University of Cantabria, Santander, Spain.

Abstract

OBJECTIVES:

The morbidity and mortality of patients with rheumatic diseases has improved considerably following the use of biologic therapies. However, an increase in the frequency of bacterial infections has been observed in patients receiving these drugs. In the present study we aimed to establish the incidence and clinical manifestations of non-typhi Salmonella infection in a large cohort of patients with rheumatic diseases undergoing TNF-alpha antagonist therapy due to severe rheumatic diseases refractory to conventional therapies.

METHODS:

The rate of non-typhi Salmonella infection found in the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases (BIOBADASER) was compared with that observed in a cohort of rheumatoid arthritis (RA) patients from the EMECAR (Morbidity and Clinical Expression of Rheumatoid Arthritis) Study, who were not treated with TNF-alpha antagonists. The rate found in the BIOBADASER registry was also compared with that available in a non-RA historic control cohort reported in a population from Huesca (Northern Spain).

RESULTS:

Seventeen cases of non-typhi Salmonella infection were observed in the series of patients exposed to anti-TNF-alpha therapies. The incidence rate of non-typhi Salmonella in BIOBADASER was 0.73 per 1000 patient-years (95% confidence interval [CI]: 0.45-1.17). The incidence rate in the EMECAR cohort was 0.44 per 1000 patient-years. The relative risk for non-typhi salmonellosis in RA patients exposed to TNF-alpha inhibitors compared to those not treated with biological therapies was 2.07 (95% CI: 0.27-15.73) (p=0.480) whereas the relative risk of non-typhi Salmonella infections in patients with rheumatic diseases undergoing TNF-alpha antagonist therapy compared with the non-RA Spanish control cohort was 0.63 (95% CI: 0.38-1.04) (p=0.07). Nine of the 17 patients with non-typhi salmonellosis presented a severe systemic infection.

CONCLUSION:

Incidence of non-typhi Salmonella infection is not increased significantly in rheumatic patients undergoing anti-TNF-alpha therapy when compared with RA patients undergoing conventional DMARD therapy or with the general population. Nevertheless, at least 50% of patients on TNF-alpha have severe complications once they develop non-typhi Salmonella infection. This fact suggests that anti-TNF-alpha therapies may predispose to salmonella dissemination rather than to infection.

PMID:
20149306
[Indexed for MEDLINE]

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