LAUSR

Background Many treatments for rheumatic diseases, especially the new ones such as anti-TNF or anti-IL6 therapies, are known to increase the risk of tuberculosis (TB) and nontuberculous mycobacterial (NTM) infections. Objectives To determine the incidence of mycobacterial infections in patients of the rheumatology unit in our hospital. Methods We retrospectively reviewed the results of microbiological studies for the detection of mycobacteria requested for patients of the Rheumatology service in our hospital from January 1, 2008 to October 1, 2017. We reviewed the clinical histories of the patients in whom a positive result was obtained. Different clinical and microbiological parameters were collected: age, gender, type of sample, isolated germ, infection location, antimicrobial treatment, main basal disease and immunosuppressive treatment received at the time of sampling. Results We reviewed 719 samples from 311 patients. The 28 samples that were positive for mycobacteria corresponded to 16 patients (50% males, with a mean age of 58.6 years). M. avium complex (MAC) was isolated in 10 patients, M.tuberculosis complex (MTB) in 4 patients and M. gordonae in two cases. Seven clinical infections occurred (5% of the total studied patients), 4 due to MTB and 3 to MAC. The predominant involvement was pulmonary (5 patients, one of them also with spondylodiscitis); one patient had infectious oligoarthritis with cutaneous involvement and another patient lymph node involvement. Six of the 7 patients with mycobacterial infection were receiving chronic treatment with prednisone (or equivalent dose of corticosteroids)>5 mg/day (85.71%). In two of them adalimumab was associated, and methotrexate in other two. Conclusions The incidence of mycobacterial infections in patients with rheumatic diseases has increased, coupled with prolonged corticosteroid therapy – sometimes at high doses – and biological therapies. In our unit, an incidence of mycobacterial infections of 5% has been observed in the last 10 years. Most of the patients with clinical infection were under treatment with prednisone (or equivalent dose of corticosteroids)>5 mg/day. We conclude that the need for chronic corticosteroid therapy should be balanced carefully in each patient, trying to reduce the dose and/or suspend it as soon as possible. Disclosure of Interest None declared