Background/Purpose: There is a general impression that the patients with giant cell arteritis (GCA) on glucocorticoid therapy are at higher risk for infections. We aimed to assess the occurrence of infections requiring or acquired during hospitalizations in patients with GCA.
Methods: We retrospectively reviewed a population-based incidence cohort of GCA patients diagnosed between 1950 and 2009 based on American College of Rheumatology 1990 GCA classification criteria. We also included patients ≥ 50 years of age with elevation of erythrocyte sedimentation rate or C-reactive protein and computed tomography, magnetic resonance imaging or positron emission tomography evidence of large vessel vasculitis involving ascending aorta and its branches. We compared this cohort with age, sex and calendar year matched cohort from the same population. All subjects were longitudinally followed through all available community medical records until death, migration or April 30, 2013. Data was collected on all documented episodes of infection requiring or acquired during hospitalization after the GCA incidence/index date. Infection rates were calculated using person-year methods.
Results: We identified 245 patients in the GCA cohort and 245 age, sex and calendar year matched patients in the non-GCA cohort. Baseline characteristics including mean age, sex and length of follow up were similar between the two groups. 74 GCA (134 episodes) and 79 non-GCA (153 episodes) subjects had infections requiring, or acquired during hospitalizations [Rate ratio (RR) 0.94; 95% confidence interval (CI) 0.74, 1.18]. 67 subjects (107 episodes) in GCA cohort and 63 subjects (110 episodes) in non-GCA cohort required hospitalization secondary to an infection [RR 1.04; 95% CI (0.80, 1.36)]. Pneumonia [RR 0.76; 95% CI (0.48, 1.17)], urinary tract infections [RR 0.81; 95% CI (0.43, 1.47)], skin and soft tissue infections [RR 0.83; 95% CI (0.36, 1.87)] accounted for the majority of infections requiring hospitalizations and had similar occurrence in both cohorts.
9 episodes of infections requiring hospitalization occurred in the first 6 months in GCA cohort as opposed to 5 in non-GCA cohort [RR 1.85; 95% CI (0.67, 6.01)]. Urinary tract infections accounted for the majority of infections requiring hospitalization in the first 6 months after GCA incidence [RR 3.93; 95% CI (0.85, 56.52)].
No difference between the two cohorts was noted in overall infections acquired during hospitalizations [RR 0.68; 95% CI (0.41, 1.08)]. Median length of hospital stay was 5 days and median duration of antibiotic use was 10 days in each cohort among infection episodes requiring hospitalizations.
Conclusion: There is no overall increased risk of infections requiring or acquired during hospitalizations in patients with giant cell arteritis on glucocorticoid therapy. There may be an increased risk of infections requiring hospitalization, especially of the urinary tract in the first six months after GCA incidence although this did not achieve statistical significance in our study. Overall length of hospital stay and duration of antibiotic use is not different in patients with GCA requiring hospitalization because of infection.
Disclosure:
P. D. Udayakumar,
None;
A. K. Chandran,
None;
C. S. Crowson,
None;
K. J. Warrington,
None;
E. L. Matteson,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/infections-requiring-or-acquired-during-hospitalizations-in-patients-with-giant-cell-arteritis-a-population-based-retrospective-cohort-study/