ANCA ile ilişkili vasküliti olan hastalarda görülen enfeksiyonlar ve neden olan mikroorganizmalar

Year 2023, Volume: 48 Issue: 1, 253 - 260, 31.03.2023

Gizem Varkal , İpek Türk , Özlem Doğan Ağbuga , Mehmet Ali Aşık Şerife Şeyda Zengin Acemoğlu Kaniye Aydın , Didem Arslan , Hüseyin Turgut Elbek Özer

https://doi.org/10.17826/cumj.1218642

Abstract

Amaç: Bu çalışmada ANCA ilişkili vasküliti (AİV) olan hastalarda hastaneye yatış gerektiren enfeksiyonlarının saptanması amaçlanmıştır.
Gereç ve Yöntem: AİV’li Türk hastalarda yapılmış tek merkezli, retrospektif bir çalışmadır. Hastanede yatış gerektiren enfeksiyon atakları, üreyen patojenler, laboratuvar bulguları, vaskülit tedavisi için verilen immünsüpresif tedaviler ve enfeksiyon ile ilişkisi değerlendirildi.
Bulgular: AİV tanısı alan 74 hasta çalışmaya dahil edildi. Hastaların 36’sında enfeksiyon nedeniyle hastaneye yatış görüldü. Enfekte hasta grubunda diabetes mellitus (DM) birlikteliği anlamlı olarak yüksek bulundu. Siklofosfamid (SP) tedavisinin enfeksiyon riskini artırdığı bulundu. Enfekte hasta grubunun %80'den fazlası böbrek tutulumu ile başvurdu (%80,6). Otuz altı hastada toplam 68 enfeksiyon epizodu görüldü. En sık enfeksiyon tutulumu %70,6 ile solunum yolu idi. Gram-negatif bakteriler, özellikle Pseudomonas aeruginosa olmak üzere en yaygın patojendi. Pandeminin de etkisiyle viral enfeksiyonlar arasında SARS-CoV-2 ön plana çıktı. Aspergilloz, mantar enfeksiyonları arasında en sık saptanandı. Ayrıca aspergilloz, mantar enfeksiyonlarının %85,7'sinin (6 atak) nedeniydi. Enfeksiyon ataklarının %76,5'inde lenfopeni gözlendi. Enfeksiyonların %57,4'ü indüksiyon tedavisinin ilk yılında gelişmiştir. Enfeksiyöz ataklarda vaskülit tedavisinde en sık kullanılan immünsüpresif tedavi SP (%41,2) idi.
Sonuç Vaskülit tedavisi sırasında enfeksiyonları yönetmek çok önemlidir. Lenfopeni, böbrek tutulumu, DM ve immünsüpresif tedavi enfeksiyon riskini artıran faktörlerdir. Klinisyenler patojen olarak özellikle solunum yolu enfeksiyonları ve gram negatif bakteriler için önleyici tedbirler almalıdır.

Keywords

ANCA ile ilişkili vaskülit, enfeksiyon, immünsüpresyon, lenfopeni

Supporting Institution

destek alınmamıştır.

Project Number

117/55

Infections and causative microorganisms in patients with ANCA-associated vasculitis

Abstract

Purpose: The aim of this study was to detect infections requiring hospitalization in patients with ANCA-associated vasculitis (AAV).
Materials and Methods: This is a single-center, retrospective study conducted in Turkish patients with AAV. Infection episodes requiring hospitalization, reproducing pathogens, laboratory findings, immunosuppressive treatments given for the treatment of vasculitis, and the relationship with the infection were evaluated.
Results: Seventy-four patients diagnosed with AAV were included in the study. Hospitalization due to infection was observed in 36 of the patients. The coexistence of diabetes mellitus (DM) was found to be significantly higher in the infected patient group. Cyclophosphamide (CYC) treatment found to increase risk of infection. More than 80% of the infected patient group presented with renal involvement (80.6%). A total of 68 infectious episodes were seen in 36 patients. The most common involvement of infection was the respiratory tract with a rate of 70.6%. Gram-negative bacteria were the most common pathogen, especially Pseudomonas aeruginosa. With the effect of the pandemic, SARS-CoV-2 has come to the fore among viral infections. Aspergillosis was the most frequently detected among fungal infections. Besides, aspergillosis was the cause of 85.7% (6 episodes) of fungal infections. Lymphopenia was observed in 76.5% of the infection episodes. 57.4% of infections developed in the first year of the induction therapy. The most frequently used immunosuppressive therapy for the treatment of vasculitis in infectious episodes was CYC (41.2%).
Conclusion: Managing infections during the vasculitis treatment is crucially important. Lymphopenia, kidney involvement, DM and immunosuppressive therapy are factors that increase the risk of infection. Clinicians should take preventive measure especially for respiratory tract infections and gram-negative bacteria as pathogens.

Keywords

ANCA-associated vasculitis, infection, immunosuppression, lymphopenia

Project Number

117/55

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