Department of Dermatology, Hôpital Cochin, APHP, Université René Descartes Paris V, Paris, France.
Dermatology. 2012;224(1):72-83. doi: 10.1159/000337422. Epub 2012 Apr 6.
The incidence of severe infections is increased under biologic therapies and the skin is the second localization.
To appraise the factors associated with severe skin infections (SSI) in patients under biologic therapies for inflammatory rheumatic diseases (IRD).
We performed a case-control (ratio 1:3) study nested in a prospective cohort of patients with IRD. SSI was defined as requiring hospitalization or intravenous anti-infectious therapy. We defined two imbedded periods: period A was the time window between the first biologic therapy and the SSI; period B was the last 3 or 12 months (for tumor necrosis factor blockers or rituximab, respectively) before the SSI.
Among 4,361 patients with IRD, 29 had a SSI under biologic therapy. In multivariate analyses, SSI were significantly associated with smoking, baseline C-reactive protein and gammaglobulinemia, non-steroidal anti-inflammatory drugs before biologic therapy, cumulative dose of steroids, concomitant steroids during period A, number of different biologic therapies during period A, treatment with infliximab during period A, period B or as first biologic therapy and treatment at high dose during period B.
In patients under biologic therapies for IRD, the risk of SSI is associated with several factors including tobacco, treatment with infliximab or high dose range.
生物治疗会增加严重感染的发生率，皮肤是第二个受累部位。
评估生物治疗的炎症性风湿病（IRD）患者严重皮肤感染（SSI）的相关因素。
我们进行了一项病例对照研究（1:3 比例），嵌套在 IRD 患者的前瞻性队列中。SSI 的定义为需要住院或静脉抗感染治疗。我们定义了两个嵌入期：A 期为首次生物治疗和 SSI 之间的时间窗；B 期为 SSI 前最后 3 或 12 个月（分别针对肿瘤坏死因子阻滞剂或利妥昔单抗）。
在 4361 名 IRD 患者中，有 29 名患者在生物治疗下发生 SSI。在多变量分析中，SSI 与吸烟、基线 C 反应蛋白和γ球蛋白血症、生物治疗前的非甾体抗炎药、累积剂量的类固醇、A 期期间同时使用类固醇、A 期期间使用的不同生物治疗药物的数量、A 期期间使用英夫利昔单抗、B 期或作为一线生物治疗以及 B 期高剂量治疗显著相关。
在接受生物治疗的 IRD 患者中，SSI 的风险与多种因素相关，包括吸烟、使用英夫利昔单抗或高剂量范围。
