POS-138 SEVERE INFECTIONS IN ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS: CLINICO-BACTERIOLOGICAL PROFILE AND RISK FACTORS

Abstract

Infections are the leading cause of morbidity and mortality in patients with Antineutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis (AAV) especially during the first year of follow-up. Indeed, patients with AAV are at high risk of infection because of immunodepression secondary to the vasculitis itself and to immunosuppressive therapies. Few studies have looked at this subject in our country. The aim of our study is to determine the clinical biological and bacteriological profile as well as the factors of gravity of severe infections during AAV. It was a retrospective monocentric study carried out in the department of internal medicine A at Charles Nicolle Hospital including patients followed for AAV between January 1973 and December 2016 who presented at least one severe infection. An infection was considered severe if it required hospitalization or intravenous antibiotic therapy or if it resulted in death. 68 patients were followed for AAV during the study period. 18 patients had at least one severe infection, that was 26.5% of all patients with AAV. The mean age at diagnosis was 50 +/-14 years. The sex ratio was 1. 39% of patients were hypertensive 22% diabetics and 50% smokers. The subtypes of VAA were: nine cases of microscopic polyangiitis, eight cases of granulomatosis with polyangiitis and one case of eosinophilic granulomatosis with polyangiitis. ANCA were positive in all of our patients. Renal involvement was noted in all cases, kidney biopsy was performed in 72% of cases. VAA treatment included corticostreroids cyclophosphamid mycophenolate mofetil and Rituximab. We have identified 55 infections, the median was three infections per patient [2-3,25]. The first infection occurred 41 days [1-443] after diagnostic confirmation and 30.5 days [-9 - 443] after the start of immunosuppressive therapy. Two of our patients died from infection before receiving any immunosuppressive treatment. The other patients received at least one immunosuppressive treatment before the first infection. The most frequent infectious sites were pulmonary (29% of cases) and urinary (20%). 74% of infections were bacterial 20% fungal and 6% viral. Microbiological documentation was possible in 55% of cases. Opportunistic infections accounted for 26.7% of documented infections. Eight patients received cotrimoxazole pneumocystosis prophylaxis. Seven deaths from septic shock resulted in an infection mortality of 10.3%.Age, comorbidities, type of vasculitis, the type of immunosuppressive therapy lymphopenia and the location of infection did not have a statistically significant relationship with death from septic shock. However, lymphopenia and plasma exchange were associated with hospitalization in intensive care. Infections are a common and serious complication during AAV. Preventive measures should be adopted such as anti-pneumocystosis prophylaxis but also the generalization of anti-pneumococcal vaccination and antiviral prophylaxis.