Prevalence of Pneumococcal Vaccination in Rheumatologic Patients with Community Acquired Pneumonia. Biobadasar Registry

ALEJANDRO BENITEZ ; IGNACIO JAVIER GANDINO; BELÉN BARRIOS; MARÍA VICTORIA COLLADO ; ROSANA QUINTANA ; MERCEDES DE LA SOTA; MARIA SILVIA LARROUDE ; CRISTINA BATTAGLIOTTI ; GIMENA GOMEZ ; ANALIA BOHR; OSVALDO CERDA; EDUARDO KERZBERG ; ANA QUINTEROS ; DORA PEREIRA ; PABLO ASTESANA ; ANA CAROLINA COSTI ; AMELIA GRANEL; SERGIO PAIRA ; EDUARDO MUSSANO ; GUSTAVO CASADO; KARIN KIRMAYR; ANA BERTOLI ; SIDNEY SOARES DE SOUZA; ALEJANDRO BRIGANTE JR.; OSCAR LUIS RILLO ; RETAMOZO SOLEDAD; BORIS KISLUK ; IDA EXENI ; JUAN CARLOS BARREIRA ; CAROLINA SANCHEZ ANDIA; BELEN VIRASORO ; ANA CAPPUCCIO ; LUIS ROA PEREZ; ANDREA SMICHOWSKI ; MARÍA CELINA DE LA VEGA; EDSON JAVIER VELOZO ; SANTIAGO AGUERO ; EMILIA CAVILLON ; EUGENIA BEDOYA ; INGRID PETKOVIC ; LUIS SOMMA ; FERNANDO MELO ; LEANDRO CARLEVARIS

San Diego

Congreso; ACR / ARHP ANNUAL MEETING; 2017

American College of Rheumatology

Background/Purpose:Biobadasar is a registry that monitors adverse events in patients who use biological treatments inrheumatologic diseases conducted by the Argentine Society of Rheumatology. As in othersinternational registries the community acquired pneumonia (CAP) has been detected as one of themost frequent infectological adverse events. Although all immunosuppressed patients should bevaccinated against streptococcus pneumoniae, there is a proportion of patients who are not.Evaluate the prevalence of pneumococcal vaccination in patients with CAP within the Biobadasardatabase. Assess factors associated with severe CAP in these patients.Methods:A cross-sectional, multicenter study was made in Biobadasar database from 2010 to 2016. In patientswho reported CAP data of demographics, comorbidities and state of pneumococcal immunizationwas collected.Microbiological data, treatment and outcome of the event was considered. The severity of CAP wasassessed according to the opinion of the attending physician, hospitalization, risk of life and / ordeath.Values are expressed as mean ± standard deviation, median (ranges) and frequencies (percentages),as appropriate. We performed bivariate and multivariate logistic regression analysis to identifyvariables associated with the event.Results:Of the 4029 patients enrolled in the registry, the cumulative incidence of CAP was 4.2% (n 170), 72.4%(n 123) were women. The mean age was 57 (SD +/- 14.5). Biological treatment was found in 81.8% (n139). Patient s that have received the pneumococcal vaccine were 40.6% (n = 69). Severe CAP wasdetected in 7.1% with ICU admission requirement in and 31.8% were in general admission.Streptococco Pneumoniae was the main pathogen isolated in 13% of the cases. Overall mortality was4.1%. Among the comorbidities of patients with CAP, the following were found: AHT 31.8%,Osteoporosis 16.5%, Smoking 12.9%, DBT 4.7%, interstitial lung disease 2.9%, CKD 1.8%. The mostfrequent rheumatic disease was RA in 74.5%, followed by PAs 6.5% and SLE in 6.5%. The median timeto progression of the underlying disease was 9 years (R: 1-45). A logistic regression was performed toevaluate risk factors in severe CAP. In the univariate analysis for severe CAP we found statisticalsigni cance for Smoking OR 3.88, CI95 1.063-14.22, p= 0.029 and chronic kidney disease (CKD) OR 31,CI95 2.6-376, p= 0.007. When performing a multiple logistic regression model, only renal failure OR7.39 CI95 0.003-0.38 p= 0.007 was a predictor of severe CAP. Not signi cative association withimmunosuppressive treatment (p: 0.09), age (p: 0.464), or vaccination (p: 0.937)Conclusion:The annual incidence of CAP in Argentina varies between 0.5 -1.1% while in our cohort it was fourtimes higher. The prevalence of pneumococcal vaccination was less than 50%, showing that, althoughthe literature and guidelines establish the need for vaccination, this is not so in the real world. In themultivariate analysis, only CRD was related to severe CAP. Although in the univariate analysis the CKDand the smoking habit represented factors associated with severity. We must emphasize the medicaleducation in following the international vaccination guidelines