Rheumatology Advance Access originally published online on June 19, 2008
Rheumatology 2008 47(9):1352-1357; doi:10.1093/rheumatology/ken196
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Long-term outcome and short-term survival of patients with systemic lupus erythematosus after bacteraemia episodes: 6-yr follow-up
1Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung Children's Hospital and Chang Gung University, 2Department of Health Care Management, College of Management, Chang Gung University, 3Department of Clinical Pathology, Chang Gung Memorial Hospital, 4Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan.
Correspondence to: J.-L. Huang, Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan. E-mail: long{at}adm.cgmh.org.tw
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Abstract |
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Objective. To describe the nature of bacteraemia in SLE patients and determine the short-term survival and long-term outcome of these patients.
Methods. Analysis of the medical records of 1442 SLE patients who were regularly followed up in a tertiary teaching medical centre from 2000 to 2005.
Results. Among 1442 SLE patients, 240 patients (17%) developed at least one episode of bacteraemia, corresponding to an incidence of 92.7 cases/1000 hospital admissions. Since SLE diagnosis, the overall survival of our patients was 92% at 5 yrs, 86% at 10 yrs and 79% at 15 yrs. However, after one episode of bacteraemia, the survival decreased to 76% at 30 days and 67% at 360 days. Of the 336 episodes of bacteraemia, 167 were community-acquired (49.7%) and 169 were nosocomial (50.3%). Staphylococcus aureus was the leading cause of Gram-positive bacteraemia. Among Gram-negative bacteria, non-typhoidal Salmonella and Escherichia coli were the most common species. Community-acquired Salmonella and Streptococcus bacteraemia were more common than nosocomial infections. Klebsiella and Acinetobacter spp. were significantly more responsible for nosocomial than community-acquired bacteraemia. Patients infected with Acinetobacter, Klebsiella or Pseudomonas had lower probabilities of 14-day survival (71.4, 55.6, 42.9%, respectively).
Conclusions. Among SLE patients, an episode of bacteraemia was associated with an unfavourable long-term outcome. The bacterial species significantly influenced short-term survival. Therefore, when empiric antibiotic therapy is initiated in SLE patients who are suspected of bacteraemia, we suggest use of antibiotics that are effective against Pseudomonas, Klebsiella, Acinetobacter, S. aureus, and E. coli.
KEY WORDS: Systemic lupus erythematosus, Infection, Bacteraemia, Mortality, Outcome measure
Submitted 18 November 2007;
revised version accepted 14 April 2008.
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