背景:慢性风湿性疾病的免疫调节治疗具有感染性并发症的风险。在孟加拉国,在接受免疫抑制药物治疗的患者中,关于感染模式和相关因素的信息有限.目的探讨慢性风湿病患者接受不同免疫抑制剂治疗后感染的规律和预测因素。方法这是一项回顾性研究;纳入2019年1月至2021年12月在达卡医学院附属医院风湿病门诊就诊的(新的和旧的)不同风湿病的所有确诊病例。结果489例患者中,90例(18.4%)患者有感染记录。最常见的风湿性疾病是系统性红斑狼疮(28,31.1%),强直性脊柱炎(26,28.8%),和类风湿性关节炎(20,22.2%)。COVID-19(28,31.1%)是最常见的感染,其次是尿路感染(14,15.6%),真菌感染(12,13.3%),带状疱疹(10,11.1%),肺结核(TB)(八,8.8%),潜伏性结核病(七个,7.7%),社区获得性肺炎(6,6.6%),和败血症(三,3.3%)。每天接受类固醇超过10mg(17,18.8%)的患者感染最普遍,而每天接受类固醇少于10mg的患者(6,6.7%),与感染相关的因素是(比值比,95%CI,p值)体重不足(2.3,[1.3-2.7],0.001),贫血(1.8,[1.1-5.7],0.01),中性粒细胞减少症(1.6,[1.1-2.9],<0.002),低蛋白血症(3.1,[1.6-4.9],0.001),维生素D缺乏症(1.9,[1.3-4.5],0.001),高血糖(1.5,[1.1-5.3],0.02),类固醇副作用咨询不足(1.7,[1.1-3.9],0.03),泼尼松龙>10mg/天(2.2,[1.19-4.10],0.001).结论COVID-19肺炎,尿路感染,真菌感染,结核病,带状疱疹,和社区获得性肺炎是接受不同免疫抑制药物治疗的患者中常见的感染.营养状况差等因素,贫血的存在,白细胞减少症,低蛋白血症,高血糖症,维生素D缺乏症与感染有显著关联。此外,类固醇副作用咨询不足和泼尼松龙每日摄入史(>10mg/天)也是与感染相关的重要因素.
Background Immunomodulatory therapy for chronic rheumatic disease carries a risk for infectious complications. In Bangladesh, there is limited information regarding patterns and factors associated with infections among patients receiving immunosuppressive medications. Objective The present
study aimed to find out patterns and predictors associated with infection among patients who were on different immunosuppressive medications due to chronic rheumatological disease. Methodology This was a retrospective
study; all confirmed cases of (new and old) different rheumatological diseases on disease-modifying agents attended at the rheumatology clinic of Dhaka Medical College Hospital from January 2019 to December 2021 were enrolled. Result Among 489 cases, 90 (18.4%) patients had documented infections. The most common rheumatological diseases were systemic lupus erythematosus (28, 31.1%), ankylosing spondylitis (26, 28.8%), and rheumatoid arthritis (20, 22.2%). COVID-19 (28, 31.1%) was the most commonly occurring infection followed by urinary tract infection (14, 15.6%), fungal infection (12, 13.3%), herpes zoster (10, 11.1%), pulmonary tuberculosis (TB) (eight, 8.8%), latent TB (seven, 7.7%), community-acquired pneumonia (six, 6.6%), and sepsis (three, 3.3%). Infection was most prevalent among patients who received steroids of more than 10 mg per day (17, 18.8%) than those less than 10 mg steroid per day (six, 6.7%), Factors associated with infections were (odds ratio, 95% CI, p-value) underweight (2.3, [1.3-2.7], 0.001), anemia (1.8, [1.1-5.7], 0.01), neutropenia (1.6, [1.1-2.9], <0.002), hypoalbuminemia (3.1, [1.6-4.9], 0.001), hypovitaminosis D (1.9, [1.3-4.5], 0.001), high blood sugar (1.5, [1.1-5.3], 0.02), inadequate counseling of steroid side effect (1.7, [1.1-3.9], 0.03), prednisolone >10mg/day (2.2, [1.19-4.10], 0.001). Conclusion COVID-19 pneumonia, urinary tract infections, fungal infection, tuberculosis, herpes zoster, and community-acquired pneumonia were commonly occurring infections among patients receiving different immunosuppressive medications. Factors like poor nutritional status, presence of anemia, leucopenia, hypoalbuminemia, hyperglycemia, and hypovitaminosis D had a significant association with infection. Moreover, inadequate counseling of steroid side effects and history of daily intake of prednisolone (>10mg/day) were also significant factors associated with infection.