Increased Staphylococcus aureus Nasal Carriage Rates in Rheumatoid Arthritis Patients on Biologic Therapy

Abstract

Background: Rheumatoid arthritis patients are at increased risk for periprosthetic joint infection after arthroplasty. The reason is multifactorial. Nasal colonization with Staphylococcus aureus is a modifiable risk factor; carriage rates in RA patients is unknown. The goal of this study was to determine the S. aureus nasal carriage rates of RA patients on biologics, RA patients on traditional DMARDs, and osteoarthritis. Methods: Consecutive patients with RA on biologics (+/− DMARDs), RA on non-biologic DMARDs, or OA were prospectively enrolled from April 2017 to May 2018 123 patients were determined necessary per group to show a difference in carriage rates. Patients underwent a nasal swab and answered questions to identify additional risk factors. S. aureus positive swabs were further categorized using Spa typing. Logistic regression evaluated the association with S. aureus colonization between the groups after controlling for known risk factors. Results: RA patients on biologics, 70% of whom were on DMARDs, had statistically significant increase in S. aureus colonization (37%) compared to RA on DMARDs alone (24%), or OA (20%) p = 0.01 overall. After controlling for glucocorticoids, antibiotic use, recent hospitalization, and diabetes, RA on biologics had a significant increased risk of S. aureus nasal colonization (OR=1.80, 95% CI 1.00-3.22); p=0.047). Conclusion: S. aureus colonization risk was increased for RA on biologics compared to RA not on biologics and OA. Nasal S. aureus carriage increases the risk of surgical site infection; this

Recurrent microbial keratitis and endogenous site Staphylococcus aureus colonisation

“…Although we did not find a significant difference in S. aureus nasal carriage in patients with RA between those with or without systemic immunotherapy, this may reflect that only 6 of the 35 patients with RA were not on immunotherapy. This trend would be consistent with Goodman et al, who found that patients with RA on biological drugs, such as etanercept in our study group, had a higher prevalence of S. aureus colonisation (37%) compared to those with RA on disease-modifying anti-rheumatic drugs (DMARDs) alone (24%) or control subjects affected by osteoarthritis (20%) 27 .…”

“…In this study, we have demonstrated that patients with recurrent MK are more likely to have endogenous risk factors such as RA, Sjogren’s syndrome, ectodermal dyplasia, ocular surface disease and are more likely to be on systemic immunosuppression. These conditions may predispose to an increased risk of ocular surface S. aureus colonisation 27 .…”

Staphylococcus aureus Nasal Carriage and Autoimmune Diseases: From Pathogenic Mechanisms to Disease Susceptibility and Phenotype

“…More recently, Goodman and colleagues observed that RA patients treated by biological drugs showed a statistically significant increase in S. aureus colonization (37%) compared to RA on DMARDs alone (24%), or control subjects affected by osteoarthritis (20%). This result was confirmed at logistic regression analysis, after correction for glucocorticoids and antibiotic treatment, recent hospitalization, and diabetes [126]. In RA cohort, 28% of patients was treated by adalimumab, 25.2% by etanercept, 12.2% by abatacept, and 12.2% by rituximab.…”

“…In RA cohort, 28% of patients was treated by adalimumab, 25.2% by etanercept, 12.2% by abatacept, and 12.2% by rituximab. However, no data about SA colonization rate in the different biological treatments were provided in the study [126].…”

‘Should we stop or continue conventional synthetic (including glucocorticoids) and targeted DMARDs before surgery in patients with inflammatory rheumatic diseases?’

“…Staphylococcus aureus colonisation is increased in patients with RA on biologics (OR 1.80, 95% CI 1.007 to 3.22, p=0.04) and S. aureus colonisation increases the risk of PJI (OR 2.36, 95% CI 1.13 to 4.88, p=0.02). 17 If the colonised patient is also a smoker with a BMI≥30 kg/m 2 , the risk increases further (OR 12.76–66.16, p=0.017). 18 While medication management around the time of surgery is of particular interest because of the potential for intervention, it is important to remember that infection risk in patients with RA is multifactorial.…”