Tumour necrosis factor-α inhibitors, immune-mediated inflammatory diseases, and bloodstream infections: results from a nationwide case-control study

作者：Cæcilie Leding, Alessandra Meddis, Jon Gitz Holler, Johan Burisch, Tue Wenzel Kragstrup, Lone Skov, Thomas Benfield · 发表于：Clinical Microbiology and Infection · 年份：2026 · DOI：10.1016/j.cmi.2026.02.005 · 被引用次数：2 · 研究领域：Inflammatory Bowel Disease、Rheumatoid Arthritis Research and Therapies、Microscopic Colitis

OBJECTIVES: Severe infection risk associated with tumour necrosis factor-α inhibitors (TNFis) remains a concern. We aimed to assess the association between TNFi and bloodstream infections (BSIs) in a population-based setting. METHODS: Nationwide, registry-based case-control study including all adults from 2010 to 2024 with a first-time microbiologically confirmed BSI (cases) compared with age and sex-matched controls from the general population. Users were defined as individuals with TNFi exposure within 6 months prior to the date of BSIs. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated using conditional logistic regression. We further assessed risk variation by type of TNFi, pathogen, and underlying disease. RESULTS: We included 174,137 cases and 1 741 294 controls. Users had significantly increased odds of BSIs compared with nonusers (aOR, 1.41; 95% CI, 1.30-1.52), driven by increased odds among users of adalimumab and infliximab (aOR, 1.51; 95% CI, 1.33-1.72, and aOR, 2.01; 95% CI, 1.76-2.29). The use of certolizumab pegol and etanercept was associated with lower odds of BSIs, and golimumab with higher odds compared with nonuse, although not statistically significant. Species-specific analyses showed increased odds of BSIs with Escherichia coli (aOR, 1.33; 95% CI, 1.16-1.53), Staphylococcus aureus (aOR, 1.69; 95% CI, 1.40-2.06), Streptococcus pneumoniae (aOR, 1.46; 95% CI, 1.05-2.04), and Enterococcus faecium (aOR, 1.62; 95% CI, 1.04-2.53). H...