Chest
Original ResearchChest InfectionsIncidence and Risk Factors of Legionella pneumophila Pneumonia During Anti-Tumor Necrosis Factor Therapy: A Prospective French Study
Section snippets
Materials and Methods
The RATIO registry was designed to prospectively collect all cases of microbiologically documented opportunistic and severe bacterial infections, including legionellosis, from February 1, 2004, to January 31, 2007, in patients who were receiving or had received TNF-α antagonists (see methodological details described in Tubach et al5). This study was authorized by the ethics committee of AP-HP, GHU Nord (Institutional Review Board of Paris North Hospitals, Paris 7 University, AP-HP;
Description of L pneumophila Pneumonia Cases
Twenty-seven cases of L pneumophila pneumonia were reported to the RATIO registry and were confirmed by the validation committee. All cases were confirmed as sporadic and community acquired and came from 18 different hospitals, with four sites that notified two or more cases. Patients' characteristics are listed in Table 1. Sixty percent of patients who received infliximab had received only this TNF-α antagonist, 64% of patients who received adalimumab had received only this TNF-α antagonist,
Discussion
Meta-analyses and most registries have revealed that severe infection is higher in patients receiving TNF-α antagonists than placebo or other classic treatments used for the management of chronic inflammatory diseases.19, 20, 21, 22 The most frequent severe infection is bacterial pneumonia. TNF-α antagonist use also exposes patients to increased risk of less-frequent intracellular bacterial infections, such as those caused by Mycobacterium tuberculosis, Listeria monocytogenes, L pneumophila,
Acknowledgments
Author contributions: Dr Lortholary had full access to all data and final responsibility for the decision to submit for publication.
Dr Lanternier: contributed to co-coordination of the writing committee and collection of data.
Dr Tubach: contributed to study design, statistical analysis, manuscript writing, and collection of data.
Dr Ravaud: contributed to study design and manuscript writing.
Dr Salmon: contributed to study design, cases validation, and manuscript review.
Dr Dellamonica:
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Cited by (0)
This article was presented in part at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 12-15, 2010, Boston, MA, Abstract L1-1988.
Funding/Support: The RATIO was supported by a research grant from INSERM [A-02-02-PRO-AX-11-ed.3] (Réseau de recherche clinique 2003 and 2006) and by an unrestricted grant from Abbott Laboratories [convention ratio/hum/2007-2009], Schering-Plough (now Merck & Co, Inc), and Wyeth [convention 0711RC26, 0611RC19, 0911RC02, 0511RC03, 0411RC08, 0811RC02] (now Pfizer Inc).
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
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A list of RATIO participants is located in e-Appendixes 1 and 2.