Top

Published in:

01-03-2018 | Original Article

Hospital-acquired infection in patients with systemic lupus erythematosus: a case-control study in a southern Chinese population

Authors: Zhongping Zhan, Minxi Lao, Fan Su, Dongying Chen, Liuqin Liang, Xiuyan Yang

Published in: Clinical Rheumatology | Issue 3/2018

Abstract

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.

Cervera R, Abarca-Costalago M, Abramovicz D, Allegri F, Annunziata P, Aydintug AO, Bacarelli MR, Bellisai F, Bernardino I, Biernat-Kaluza E, Blockmans D, Boki K, Bracci L, Campanella V, Camps MT, Carcassi C, Cattaneo R, Cauli A, Cervera R, Chwalinska-Sadowska H, Contu L, Cosyns JP, Danieli MG, DCruz D, Depresseux G, Direskeneli H, Domènech I, Espinosa G, Fernández-Nebro A, Ferrara GB, Font J, Frutos MA, Galeazzi M, Garcìa-Carrasco M, García Iglesias MF, García-Tobaruela A, George J, Gil A, González-Santos P, Grana M, Gül A, Haga HJ, de Haro-Liger M, Houssiau F, Hughes GR, Ingelmo M, Jedryka-Góral A, Khamashta MA, Lavilla P, Levi Y, López-Dulpa M, López-Soto A, Maldykowa H, Marcolongo R, Mathieu A, Morozzi G, Nicolopoulou N, Papasteriades C, Passiu G, Perelló I, Petera P, Petrovic R, Piette JC, Pintado V, de Pita O, Popovic R, Pucci G, Puddu P, de Ramón E, Ramos-Casals M, Rodríguez-Andreu J, Ruiz-Irastorza G, Sanchez-Lora J, Sanna G, Scorza R, Sebastiani GD, Sherer Y, Shoenfeld Y, Simpatico A, Sinico RA, Smolen J, Tincani A, Tokgöz G, Urbano-Márquez A, Vasconcelos C, Vázquez JJ, Veronesi J, Vianna J, Vivancos J, European Working Party on Systemic Lupus Erythematosus (2006) Systemic lupus erythematosus in Europe at the change of the millennium: lessons from the “Euro-Lupus Project”. Autoimmun Rev 5(3):180–186. https://doi.org/10.1016/j.autrev.2005.06.004 CrossRefPubMed

Jakes RW, Bae SC, Louthrenoo W, Mok CC, Navarra SV, Kwon N (2012) Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care Res (Hoboken) 64(2):159–168. https://doi.org/10.1002/acr.20683 CrossRef

Feldman CH, Hiraki LT, Winkelmayer WC, Marty FM, Franklin JM, Kim SC, Costenbader KH (2015) Serious infections among adult Medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis. Arthritis Rheumatol 67(6):1577–1585. https://doi.org/10.1002/art.39070 CrossRefPubMedPubMedCentral

Chen D, Xie J, Chen H, Yang Y, Zhan Z, Liang L, Yang X (2016) Infection in southern Chinese patients with systemic lupus erythematosus: spectrum, drug resistance, outcomes, and risk factors. J Rheumatol 43(9):1650–1656. https://doi.org/10.3899/jrheum.151523 CrossRefPubMed

Fei Y, Shi X, Gan F, Li X, Zhang W, Li M, Hou Y, Zhang X, Zhao Y, Zeng X, Zhang F (2014) Death causes and pathogens analysis of systemic lupus erythematosus during the past 26 years. Clin Rheumatol 33(1):57–63. https://doi.org/10.1007/s10067-013-2383-3 CrossRefPubMed

Doaty S, Agrawal H, Bauer E, Furst DE (2016) Infection and lupus: which causes which? Curr Rheumatol Rep 18(3):13. https://doi.org/10.1007/s11926-016-0561-4 CrossRefPubMed

Danza A, Ruiz-Irastorza G (2013) Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus 22(12):1286–1294. https://doi.org/10.1177/0961203313493032 CrossRefPubMed

Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725. https://doi.org/10.1002/art.1780400928 CrossRefPubMed

Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 35(6):630–640. https://doi.org/10.1002/art.1780350606 CrossRefPubMed

10.

De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE, European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group, National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group (2008) Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46(12):1813–1821. https://doi.org/10.1086/588660 CrossRefPubMedPubMedCentral

11.

Fangtham M, Magder LS, Petri MA (2014) Oral candidiasis in systemic lupus erythematosus. Lupus 23(7):684–690. https://doi.org/10.1177/0961203314525247 CrossRefPubMed

12.

Chen MJ, Tseng HM, Huang YL, Hsu WN, Yeh KW, Wu TL, See LC, Huang JL (2008) Long-term outcome and short-term survival of patients with systemic lupus erythematosus after bacteraemia episodes: 6-yr follow-up. Rheumatology (Oxford) 47(9):1352–1357. https://doi.org/10.1093/rheumatology/ken196 CrossRef

13.

Navarro-Zarza JE, Alvarez-Hernández E, Casasola-Vargas JC, Estrada-Castro E, Burgos-Vargas R (2010) Prevalence of community-acquired and nosocomial infections in hospitalized patients with systemic lupus erythematosus. Lupus 19(1):43–48. https://doi.org/10.1177/0961203309345776 CrossRefPubMed

14.

Lee J, Dhillon N, Pope J (2013) All-cause hospitalizations in systemic lupus erythematosus from a large Canadian referral centre. Rheumatology (Oxford) 52(5):905–909. https://doi.org/10.1093/rheumatology/kes391 CrossRef

15.

Teh CL, Ling GR (2013) Causes and predictors of mortality in hospitalized lupus patient in Sarawak General Hospital, Malaysia. Lupus 22(1):106–111. https://doi.org/10.1177/0961203312465780 CrossRefPubMed

16.

Al-Rayes H, Al-Swailem R, Arfin M, Sobki S, Rizvi S, Tariq M (2007) Systemic lupus erythematosus and infections: a retrospective study in Saudis. Lupus 16(9):755–763. https://doi.org/10.1177/0961203307079943 CrossRefPubMed

17.

Wang L, Wang Y, Fan X, Tang W, Hu J (2015) Prevalence of resistant gram-negative bacilli in bloodstream infection in febrile neutropenia patients undergoing hematopoietic stem cell transplantation: a single center retrospective cohort study. Medicine (Baltimore) 94(45):e1931. https://doi.org/10.1097/MD.0000000000001931 CrossRef

18.

Chen CY, Tsay W, Tang JL, Tien HF, Chen YC, Chang SC, Hsueh PR (2010) Epidemiology of bloodstream infections in patients with haematological malignancies with and without neutropenia. Epidemiol Infect 138(7):1044–1051. https://doi.org/10.1017/S0950268809991208 CrossRefPubMed

19.

Silva MF, Ferriani MP, Terreri MT, Pereira RM, Magalhaes CS, Bonfa E, Campos LM, Okuda EM, Appenzeller S, Ferriani VP, Barbosa CM, Ramos VC, Lotufo S, Silva CA (2015) A multicenter study of invasive fungal infections in patients with childhood-onset systemic lupus erythematosus. J Rheumatol 42(12):2296–2303. https://doi.org/10.3899/jrheum.150142 CrossRefPubMed

20.

Wang LR, Barber CE, Johnson AS, Barnabe C (2014) Invasive fungal disease in systemic lupus erythematosus: a systematic review of disease characteristics, risk factors, and prognosis. Semin Arthritis Rheum 44(3):325–330. https://doi.org/10.1016/j.semarthrit.2014.06.001 CrossRefPubMed

21.

Yun H, Yang S, Chen L, Xie F, Winthrop K, Baddley JW, Saag KG, Singh J, Curtis JR (2016) Risk of herpes zoster in autoimmune and inflammatory diseases: implications for vaccination. Arthritis Rheumatol 68(9):2328–2337. https://doi.org/10.1002/art.39670 CrossRefPubMedPubMedCentral

22.

Takizawa Y, Inokuma S, Tanaka Y, Saito K, Atsumi T, Hirakata M, Kameda H, Hirohata S, Kondo H, Kumagai S, Tanaka Y (2008) Clinical characteristics of cytomegalovirus infection in rheumatic diseases: multicentre survey in a large patient population. Rheumatology (Oxford) 47(9):1373–1378. https://doi.org/10.1093/rheumatology/ken231 CrossRef

23.

Chen GL, Chen Y, Zhu CQ, Yang CD, Ye S (2012) Invasive fungal infection in Chinese patients with systemic lupus erythematosus. Clin Rheumatol 31(7):1087–1091. https://doi.org/10.1007/s10067-012-1980-x CrossRefPubMed

24.

Dubula T, Mody GM (2015) Spectrum of infections and outcome among hospitalized South Africans with systemic lupus erythematosus. Clin Rheumatol 34(3):479–488. https://doi.org/10.1007/s10067-014-2847-0 CrossRefPubMed

Title: Hospital-acquired infection in patients with systemic lupus erythematosus: a case-control study in a southern Chinese population
Authors: Zhongping Zhan
Minxi Lao
Fan Su
Dongying Chen
Liuqin Liang
Xiuyan Yang
Publication date: 01-03-2018
Publisher: Springer London
Published in: Clinical Rheumatology / Issue 3/2018
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-017-3919-8

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Hospital-acquired infection in patients with systemic lupus erythematosus: a case-control study in a southern Chinese population

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2018

Non-tuberculous mycobacterium bacteraemia in a pregnant systemic lupus erythematosus (SLE) patient: a case review and pooled case analysis

Differential diagnostic perspectives provided by en face microscopic examination of articular surface defects

Prevalence of rheumatoid cachexia assessed by bioelectrical impedance vector analysis and its relation with physical function

Remission assessment of rheumatoid arthritis in daily practice in China: a cross-sectional observational study

Clinical features, outcome, and associated factors for posterior reversible encephalopathy in Thai patients with systemic lupus erythematosus: a case-control study

Therapeutic response to prednisone in relation to age in polymyalgia rheumatica: a comparison study

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page