Chen Dongying, Xie Jingyi, Chen Haihong, Yang Ying, Zhan Zhongping, Liang Liuqin, Yang Xiuyan
From the Department of Rheumatology, and Department of Respiratory, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou; Department of Rheumatology, Shen Zhen People's Hospital, Shenzhen, China.D. Chen, MD, Department of Rheumatology, the First Affiliated Hospital of Sun Yat-sen University; J. Xie, MD, Department of Rheumatology, Shen Zhen People's Hospital; H. Chen, MD, Department of Respiratory, the First Affiliated Hospital of Sun Yat-sen University; Y. Yang, MD, Department of Rheumatology, the First Affiliated Hospital of Sun Yat-sen University; Z. Zhan, MD, Department of Rheumatology, the First Affiliated Hospital of Sun Yat-sen University; L. Liang, MD, Department of Rheumatology, the First Affiliated Hospital of Sun Yat-sen University; X. Yang, MD, Department of Rheumatology, the First Affiliated Hospital of Sun Yat-sen University.
J Rheumatol. 2016 Sep;43(9):1650-6. doi: 10.3899/jrheum.151523. Epub 2016 Jun 15.
To investigate the spectrum, antibiotic-resistant pattern, risk factors, and outcomes of infection in patients hospitalized with systemic lupus erythematosus (SLE).
We collected the clinical and microbiological data from hospitalized patients with SLE with infection between June 2005 and June 2015, and then conducted retrospective analyses.
Among our sample of 3815 hospitalized patients, 1321 (34.6%) were diagnosed with infection. The majority (78.3%) of infection occurred within 5 years of SLE onset. Bacterial infection was predominant (50.6%), followed by viral infection (36.4%) and fungal infection (12.5%). The lungs (33.7%) and upper respiratory tracts (26.3%) were most commonly affected. Gram-negative bacteria (GNB) were predominant over gram-positive bacteria (178 isolates vs 90 isolates). The most frequently isolated bacteria were Escherichia coli (24.6%), followed by Acinetobacter baumannii (13.4%) and coagulase-negative Staphylococcus (13.4%). Multidrug-resistant (MDR) strains were detected in 26.9% of bacterial isolates. The most common fungus was Candida spp. (99 episodes), followed by Aspergillus (24 episodes) and Cryptococcus neoformans (13 episodes). The overall mortality rate for this cohort was 2.2%; 48 patients died of infection. Factors associated with bacterial and viral infection were higher Systemic Lupus Erythematosus Disease Activity Index, renal involvement, thrombocytopenia, accumulated dose of glucocorticoids (GC), and treatment with cyclophosphamide (CYC). Renal involvement, accumulated dose of GC, and treatment with CYC were associated with fungal infection.
Infection was the leading cause of mortality in patients hospitalized with SLE. There were some notable features of infection in Chinese patients including early onset, higher proportion of respiratory tract involvement, predominance of GNB with emergence of MDR isolates, and a variety of pathogens.
探讨系统性红斑狼疮（SLE）住院患者感染的谱型、耐药模式、危险因素及转归。
收集2005年6月至2015年6月期间因感染住院的SLE患者的临床和微生物学数据，然后进行回顾性分析。
在我们的3815例住院患者样本中，1321例（34.6%）被诊断为感染。大多数感染（78.3%）发生在SLE发病后5年内。细菌感染占主导（50.6%），其次是病毒感染（36.4%）和真菌感染（12.5%）。肺部（33.7%）和上呼吸道（26.3%）是最常受累的部位。革兰阴性菌（GNB）多于革兰阳性菌（178株对90株）。最常分离出的细菌是大肠埃希菌（24.6%），其次是鲍曼不动杆菌（13.4%）和凝固酶阴性葡萄球菌（13.4%）。26.9%的细菌分离株检测到多重耐药（MDR）菌株。最常见的真菌是念珠菌属（99例），其次是曲霉菌（24例）和新型隐球菌（13例）。该队列的总死亡率为2.2%；48例患者死于感染。与细菌和病毒感染相关的因素包括较高的系统性红斑狼疮疾病活动指数、肾脏受累、血小板减少、糖皮质激素（GC）累积剂量以及环磷酰胺（CYC）治疗。肾脏受累、GC累积剂量以及CYC治疗与真菌感染相关。
感染是SLE住院患者死亡的主要原因。中国患者的感染有一些显著特征，包括发病早、呼吸道受累比例较高、GNB占优势且出现MDR分离株以及多种病原体。
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