High risk of bloodstream infections, diverse causal pathogens, and association with haemodialysis and plasma exchange in ANCA-associated vasculitis

OBJECTIVES: Infections from immunosuppressive treatment are a major cause of hospitalization and mortality in ANCA-associated vasculitis (AAV). This study examines bloodstream infections (BSIs) in incident AAV patients, comparing incidence, bacterial distribution and risk to the general population, with emphasis on central venous catheters (CVCs).

METHODS: Using Danish nationwide registries, we studied patients diagnosed from 2010 to 2018, followed until first BSI, death or a maximum of 5 years. Controls were matched 1:4 by age and sex. Cumulative incidence was estimated using Aalen-Johansen, and adjusted Cox regression modelled survival time.

RESULTS: A total of 111 BSIs were identified in 80 (8.5%) of 937 AAV patients, compared with 65 BSIs in 58 (1.7%) of 3476 controls. The incidence of BSIs was significantly higher in AAV patients (34.5/1000 person-years against 4.8/1000 person-years). One-year hazard ratio (HR) for first-time BSIs was significantly elevated in AAV patients (HR 10.5, [95% CI 5.58-11.9]), and those receiving haemodialysis (HR 34.8, 95% CI 3.35-360.8) or plasma exchange (HR 14.6, 95% CI 3.79-56.6) faced even higher infection rates. Following first-time BSI, one-year mortality rates were equally high in AAV patients (36.3%) and controls (34.5%). Most common microbial agents-Escherichia coli, Staphylococcus aureus, enterococci and streptococci-were similar between the two groups. However, AAV patients exhibited higher microbial diversity, with 48.6% attributed to other pathogens like coagulase-negative staphylococci, Klebsiella pneumoniae, Pseudomonas aeruginosa and fungi.

CONCLUSION: AAV patients face high BSI risk, diverse microbiology and increased one-year mortality, with CVC-related interventions as solitary risk factors.