Background Bacterial pneumonia is most common respiratory complication in rheumatoid arthritis (RA) patients treated with biologics. There are few reports about detail of pathogenic bacteria or guideline to make a decision on the treatment.
Objectives To investigate the outline of bacterial pneumonia in RA patients treated with biologics focusing on pathogens and therapeutic intervention.
Methods 1575 RA patients were registered in multi-center registry for the treatment of RA with biologics in Japan (Tsurumai Biologics Communication registry; TBCR) till 2011. 57 cases were interrupted or discontinued the biologics administration due to respiratory infectious complication. We reviewed medical records of those patients and assessed about the pathogens and therapeutic intervention especially in antimicrobial agents retrospectively.
Results Excluded the cases of tuberculosis, non tuberculous mycobacteriosis and pneumocystis pneumonia, 31 cases (2.0%) of biologics related bacterial pneumonia (BRP) were investigated. BRP group showed significantly higher age, baseline DAS and longer disease duration (Table 1). The character of BRP was biphasic. 6cases with mild symptoms were successfully treated with oral fluoroquinolones or macrolides without detecting the pathogens in ambulatory care. But 13cases with severe symptoms that’s pathogens were isolated, all patients needed parenteral antimicrobial therapy under hospitalization. Isolated pathogens were higher pathogenic as presented in Table 2. Resistant bacterium such as BLNAR or MRSA were isolated in one case (7.7%) respectively. yogenic or atypical isolates tend to be more often from Community-acquired pneumonia (CAP) to Hospital-acquired pneumonia (HAP) as reported in previous reports, and BRP showed the profile among CAP and Healthcare-associated pneumonia (HCAP) as showed in Table 3.
Conclusions The BRP profile of pathogens corresponded with that of HCAP or HAP rather than that of CAP. Classifying criteria for BRP should be established, and if the patient needs intensive care for severe symptoms, therapeutic decision should be made under consideration about resistant bacteria or atypical pathogens as recommended in HCAP or HAP guideline.
Disclosure of Interest D. Kato: None Declared, T. Kojima Speakers Bureau: Abbott Japan, Chugai Pharmaceutical, Bristol-Myers Squibb, Eisai, Mitsubishi Tanabe, Pharma, Pfizer Japan, Takeda Pharmaceutical, N. Takahashi: None Declared, K. Funahashi: None Declared, H. Matsubara: None Declared, Y. Hattori: None Declared, N. Ishiguro Speakers Bureau: Abbott Japan, Chugai Pharmaceutical, Bristol-Myers Squibb, Eisai, Mitsubishi Tanabe, Pharma, Pfizer Japan, Takeda Pharmaceutical