Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Clin Rheumatol. 2018 Mar;37(3):709-717. doi: 10.1007/s10067-017-3919-8. Epub 2017 Nov 27.
The objective of this study is to investigate the current situation of hospital-acquired infection (HAI) in lupus patients from a southern Chinese population. A case-control study was performed. Data from Jan. 2007 to Jan. 2017 were collected. Each lupus patient with HAI was compared with two control individuals without infection selected from the same period of time. Three hundred and sixty episodes of HAI were analyzed. The average Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score at admission was 13.2 ± 7.2. The respiratory tract (58.8%) was most commonly involved, followed by the bloodstream (10.9%). Most episodes were bacteria-associated (50.0%), followed by viral infection (34.8%) and fungal infection (15.2%). Pathogenic bacteria were isolated in 87 episodes, among which 60 episodes were gram-negative bacteria (GNB)-related. Multidrug-resistant strains were detected in 46.4% of bacterial isolates. Fungi were isolated in 49 episodes. Candida albicans (46.9%) was the leading pathogen. Fifty-four episodes of virus infection were confirmed. In multivariate analysis, SLEDAI score (OR 1.1, 95% CI 1.1-1.2, P < 0.001), lupus nephritis (OR 3.7, 95% CI 2.7-5.1, P < 0.001), high dose of GC (OR 2.7, 95% CI 1.8-3.9, P < 0.001), and treatment with CYC (OR 2.9, 95% CI 2.1-4.0, P < 0.001) were risk factors for HAI. HAI in Chinese lupus patients had a unique epidemiology feature, which was characterized by common respiratory tract and bloodstream involvement and predominance of GNB with a high drug resistance rate. A variety of new pathogens including fungi and viruses emerged in the HAI patients. A history of nephritis or a higher SLEDAI score in SLE patients predicted HAI. Moreover, treatment with high dose of GC and CYC was also the main risk factor for HAI.
本研究旨在调查中国南方人群狼疮患者医院获得性感染 (HAI) 的现状。采用病例对照研究。收集了 2007 年 1 月至 2017 年 1 月的数据。将每位患有 HAI 的狼疮患者与同一时期选择的两名无感染对照个体进行比较。分析了 360 例 HAI。入院时平均系统性红斑狼疮疾病活动指数 (SLEDAI) 评分为 13.2±7.2。呼吸道（58.8%）最常受累，其次是血流（10.9%）。大多数感染与细菌有关（50.0%），其次是病毒感染（34.8%）和真菌感染（15.2%）。87 例分离出病原菌，其中 60 例与革兰阴性菌（GNB）有关。在细菌分离物中检测到 46.4%的多药耐药株。49 例分离出真菌。白色念珠菌（46.9%）是主要病原体。54 例病毒感染得到确认。多变量分析显示，SLEDAI 评分（比值比 1.1，95%置信区间 1.1-1.2，P<0.001）、狼疮肾炎（比值比 3.7，95%置信区间 2.7-5.1，P<0.001）、大剂量 GC（比值比 2.7，95%置信区间 1.8-3.9，P<0.001）和 CYC 治疗（比值比 2.9，95%置信区间 2.1-4.0，P<0.001）是 HAI 的危险因素。中国狼疮患者的 HAI 具有独特的流行病学特征，其特点是常见的呼吸道和血流感染，以及以高耐药率为主的 GNB。在 HAI 患者中出现了多种新的病原体，包括真菌和病毒。狼疮患者有肾炎病史或 SLEDAI 评分较高，预示着 HAI。此外，大剂量 GC 和 CYC 的治疗也是 HAI 的主要危险因素。
