Likelihood of infections and antimicrobial use associated with infections and severe infections before and after IgRT initiation among patients with MM who received ≥1 IgRT
| . | 3 months n= 370 . | 6 months n = 175 . | 12 months n = 137 . | |||
|---|---|---|---|---|---|---|
| OR (95% CI)∗ . | P value . | OR (95% CI)∗ . | P value . | OR (95% CI)∗ . | P value . | |
| Infections† | ||||||
| All infections‡ | 0.71 (0.56-0.89) | .004§ | 0.75 (0.58-0.96) | .026§ | 0.83 (0.62-1.11) | .210 |
| Individual infection | ||||||
| Sinopulmonary and skin or soft tissue infections | 0.62 (0.47-0.81) | .001§ | 0.71 (0.54-0.94) | .018§ | 0.83 (0.63-1.11) | .209 |
| Pneumonia | 0.73 (0.53-0.99) | .040§ | 0.76 (0.55-1.06) | .106 | 0.85 (0.60-1.21) | .370 |
| Ear-nose-throat infection | 1.22 (0.65-2.31) | .532 | 1.27 (0.69-2.34) | .450 | 1.11 (0.64-1.96) | .706 |
| Bronchitis | 0.46 (0.26-0.82) | .008§ | 0.57 (0.34-0.96) | .034§ | 0.63 (0.38-1.04) | .071 |
| Skin/soft tissue/joint/bone infection | 0.64 (0.37-1.11) | .110 | 0.81 (0.51-1.29) | .371 | 1.23 (0.75-2.03) | .414 |
| Other infections | 0.61 (0.40-0.93) | .022§ | 0.84 (0.54-1.29) | .414 | 0.78 (0.52-1.19) | .249 |
| Severe infections†,|| | ||||||
| All severe infections | 0.47 (0.36-0.62) | <.0001§ | 0.46 (0.35-0.62) | <.0001§ | 0.46 (0.35-0.62) | <.0001§ |
| Individual infection | ||||||
| Sinopulmonary and skin or soft tissue infections | 0.46 (0.32-0.65) | <.0001§ | 0.49 (0.34-0.71) | <.0001§ | 0.49 (0.34-0.71) | <.0001§ |
| Pneumonia | 0.60 (0.41-0.87) | .007§ | 0.61 (0.41-0.90) | .013§ | 0.61 (0.41-0.90) | .013§ |
| Ear-nose-throat infection | 0.42 (0.12-1.44) | .169 | 0.60 (0.17-2.09) | .419 | 0.60 (0.17-2.09) | .419 |
| Bronchitis | 0.34 (0.14-0.85) | .021§ | 0.43 (0.18-1.02) | .055 | 0.43 (0.18-1.02) | .055 |
| Skin/soft tissue/joint/bone infection | 0.38 (0.14-1.01) | .053 | 0.55 (0.26-1.15) | .112 | 0.55 (0.26-1.15) | .112 |
| Other infections | 0.50 (0.31-0.81) | .005§ | 0.63 (0.38-1.04) | .071 | 0.63 (0.38-1.04) | .071 |
| Antimicrobial use¶ | ||||||
| Antimicrobial use associated with infections | ||||||
| Infection episodes requiring antibiotic use | 0.48 (0.37-0.62) | <.0001§ | 0.58 (0.44-0.75) | <.0001§ | 0.63 (0.47-0.84) | <.0001§ |
| Infection episodes requiring antiviral use | 0.51 (0.38-0.67) | <.0001§ | 0.55 (0.41-0.74) | <.0001§ | 0.67 (0.49-0.92) | <.0001§ |
| Infection episodes requiring antifungal use | 0.48 (0.34-0.69) | <.0001§ | 0.52 (0.36-0.75) | <.0001§ | 0.58 (0.40-0.84) | .004§ |
| Antimicrobial use associated with severe infections | ||||||
| Severe infection episodes requiring antibiotic use | 0.41 (0.31-0.55) | <.0001§ | 0.45 (0.33-0.61) | <.0001§ | 0.49 (0.36-0.66) | <.0001§ |
| Severe infection episodes requiring antiviral use | 0.42 (0.31-0.57) | <.0001§ | 0.46 (0.33-0.63) | <.0001§ | 0.50 (0.36-0.70) | <.0001§ |
| Severe infection episodes requiring antifungal use | 0.43 (0.29-0.64) | <.0001§ | 0.46 (0.30-0.69) | <.0001§ | 0.48 (0.31-0.75) | .001§ |
| . | 3 months n= 370 . | 6 months n = 175 . | 12 months n = 137 . | |||
|---|---|---|---|---|---|---|
| OR (95% CI)∗ . | P value . | OR (95% CI)∗ . | P value . | OR (95% CI)∗ . | P value . | |
| Infections† | ||||||
| All infections‡ | 0.71 (0.56-0.89) | .004§ | 0.75 (0.58-0.96) | .026§ | 0.83 (0.62-1.11) | .210 |
| Individual infection | ||||||
| Sinopulmonary and skin or soft tissue infections | 0.62 (0.47-0.81) | .001§ | 0.71 (0.54-0.94) | .018§ | 0.83 (0.63-1.11) | .209 |
| Pneumonia | 0.73 (0.53-0.99) | .040§ | 0.76 (0.55-1.06) | .106 | 0.85 (0.60-1.21) | .370 |
| Ear-nose-throat infection | 1.22 (0.65-2.31) | .532 | 1.27 (0.69-2.34) | .450 | 1.11 (0.64-1.96) | .706 |
| Bronchitis | 0.46 (0.26-0.82) | .008§ | 0.57 (0.34-0.96) | .034§ | 0.63 (0.38-1.04) | .071 |
| Skin/soft tissue/joint/bone infection | 0.64 (0.37-1.11) | .110 | 0.81 (0.51-1.29) | .371 | 1.23 (0.75-2.03) | .414 |
| Other infections | 0.61 (0.40-0.93) | .022§ | 0.84 (0.54-1.29) | .414 | 0.78 (0.52-1.19) | .249 |
| Severe infections†,|| | ||||||
| All severe infections | 0.47 (0.36-0.62) | <.0001§ | 0.46 (0.35-0.62) | <.0001§ | 0.46 (0.35-0.62) | <.0001§ |
| Individual infection | ||||||
| Sinopulmonary and skin or soft tissue infections | 0.46 (0.32-0.65) | <.0001§ | 0.49 (0.34-0.71) | <.0001§ | 0.49 (0.34-0.71) | <.0001§ |
| Pneumonia | 0.60 (0.41-0.87) | .007§ | 0.61 (0.41-0.90) | .013§ | 0.61 (0.41-0.90) | .013§ |
| Ear-nose-throat infection | 0.42 (0.12-1.44) | .169 | 0.60 (0.17-2.09) | .419 | 0.60 (0.17-2.09) | .419 |
| Bronchitis | 0.34 (0.14-0.85) | .021§ | 0.43 (0.18-1.02) | .055 | 0.43 (0.18-1.02) | .055 |
| Skin/soft tissue/joint/bone infection | 0.38 (0.14-1.01) | .053 | 0.55 (0.26-1.15) | .112 | 0.55 (0.26-1.15) | .112 |
| Other infections | 0.50 (0.31-0.81) | .005§ | 0.63 (0.38-1.04) | .071 | 0.63 (0.38-1.04) | .071 |
| Antimicrobial use¶ | ||||||
| Antimicrobial use associated with infections | ||||||
| Infection episodes requiring antibiotic use | 0.48 (0.37-0.62) | <.0001§ | 0.58 (0.44-0.75) | <.0001§ | 0.63 (0.47-0.84) | <.0001§ |
| Infection episodes requiring antiviral use | 0.51 (0.38-0.67) | <.0001§ | 0.55 (0.41-0.74) | <.0001§ | 0.67 (0.49-0.92) | <.0001§ |
| Infection episodes requiring antifungal use | 0.48 (0.34-0.69) | <.0001§ | 0.52 (0.36-0.75) | <.0001§ | 0.58 (0.40-0.84) | .004§ |
| Antimicrobial use associated with severe infections | ||||||
| Severe infection episodes requiring antibiotic use | 0.41 (0.31-0.55) | <.0001§ | 0.45 (0.33-0.61) | <.0001§ | 0.49 (0.36-0.66) | <.0001§ |
| Severe infection episodes requiring antiviral use | 0.42 (0.31-0.57) | <.0001§ | 0.46 (0.33-0.63) | <.0001§ | 0.50 (0.36-0.70) | <.0001§ |
| Severe infection episodes requiring antifungal use | 0.43 (0.29-0.64) | <.0001§ | 0.46 (0.30-0.69) | <.0001§ | 0.48 (0.31-0.75) | .001§ |
A generalized estimating equation logistic regression model with robust variance was fitted to obtain the ORs, 95% CIs, and P values for the comparison of infection and severe infection rates in the post-IgRT period and the rates in the pre-IgRT period.
Medical encounters with the same infection/severe infection diagnosis within 7 days of each other were attributed to the same infection episode.
All infections included individual infections such as sinopulmonary and skin or soft tissue infections, pyrexia unknown origin, sepsis, bacteremia, genitourinary infections, gastrointestinal infections, brain/spinal infections, COVID-19, blood infections other than sepsis, cardiac infections, and other (not otherwise specified).
Statistically significant at P value <.05.
A severe infection was defined as an infection that led to hospitalization or treatment with any IV antibiotic, antiviral, or antifungal medication.
Infection episodes that required antimicrobials were defined as medical encounters with a diagnosis of infection/severe infection and a prescription of antibiotics/antiviral/antifungal medication within 30 days for the same diagnosis.