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A2609 - Nontuberculous Mycobacterial Pulmonary Isolates and Bronchiectasis Among Persons Hospitalized with Rheumatoid Arthritis, 2009-2014, United States
Author Block: D. Prevots1, J. Adjemian1, Y. Lai1, K. L. Winthrop2, K. N. Olivier3; 1Epidemiology Unit, Division of Intramural Research, NIAID, NIH, Bethesda, MD, United States, 2Oregon Health and Sciences Univ, Portland, OR, United States, 3Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, Bethesda, MD, United States.
Rationale: Among persons with rheumatoid arthritis (RA), pulmonary manifestations are common, and chronic lung inflammation may play a role in pathogenesis. Although the increased risk of nontuberculous mycobacterial disease among persons with RA, particularly those persons being treated with anti-TNF agents, has been well characterized, the frequency of bronchiectasis in this population as well as the specific mycobacterial flora have not been well described. To better characterize these features, we studied inpatients identified with RA using the Cerner Health Facts analytic dataset, covering an estimated 12 million inpatients in hospitals distributed nationally. The analytic dataset from this electronic health record system allows for linked analysis of clinical, microbiologic, and demographic data. Methods: We identified a cohort of patients with the ICD9 codes for RA (714.0, 714.2 714.81). admitted to any of the participating hospitals between 2009-2014. In addition, we used ICD9 codes to identify persons with bronchiectasis (ICD9 494., 494.0, 494.1) among those patients identified with RA. A person with any pathogenic NTM species (e.g. excluding M. gordonae) was defined as having NTM. Results: Overall, 47,299 inpatients with RA were identified, with an average age of 65 years. In this group, 418 (0.88%) were coded as having bronchiectasis, of whom 9 (2%) had at least one NTM isolate, all of which were pulmonary. Of 46,881 RA patients without codes for bronchiectasis, 63 (0.13%) had NTM; 46 (0.10%) were pulmonary; thus, patients with RA and bronchiectasis were twenty times more likely to have pulmonary NTM identified than those without bronchiectasis. Overall, among all 55 RA patients with pulmonary NTM, 40 (73%) had Mycobacterium avium complex (MAC), 1 (1.8%) had M. abscessus, and 14 had undetermined or other species. In addition, 261 (0.55%) RA patients had pulmonary Pseudomonas aeruginosa, and 71 (0.15%) had pulmonary Aspergillus. Conclusions: Nearly 1 in every 100 hospitalized RA patients was diagnosed with bronchiectasis, and RA patients with bronchiectasis were twenty times more likely to have NTM infections than RA patients without bronchiectasis. These data highlight the increased risk of NTM and other opportunistic pathogens in this RA population, particularly in the presence of bronchiectasis. Although patients hospitalized with RA are not representative of all RA patients, nonetheless the increased risk of bronchiectasis among patients with RA is consistent with prior studies in outpatients. Further work is needed to more clearly elucidate the risks for bronchiectasis and NTM among RA patients.