Distribution And Risk Factors Of Pathogens In Patients With Systemic Lupus Erythematosus Complicated With Urinary Tract Infection

Objective: To investigate the distribution of pathogenic bacteria in patients with systemic lupus erythematosus(SLE)co-infected with urinary tract infection(UTI),and to further analyze the risk factors of SLE patients co-infected with urinary tract infection to guide clinical diagnosis and treatment.Methods: The clinical data of 270 patients with SLE hospitalized in the First Affiliated Hospital of Xinjiang Medical University from January2010 to July 2022 were retrospectively analyzed,and the patients were divided into infected(n=135)and non-infected(n=135)groups according to whether they had urinary tract infections.The distribution of the infecting pathogens was determined.A binary logistic regression analysis was performed to determine the risk factors by comparing the differences in clinical indicators between the two groups of SLE patients.Results:In this study,there was no significant significance between sex and age between the infected and non-infected groups.The number of days of hospitalization,the number of systems involved,and the SLEDAI scores between the two groups were 0-4(P<0.001),5-10(P=0.007),and >10(P=0.021),all of which were statistically significant.Among the organs involved: renal involvement,central nervous system involvement,hematologic system,respiratory system,and serous cavity were statistically different(P<0.05)The C3,serum albumin and blood lymphocyte counts of the infected group were lower than those in the non-infected group,and the P<0.05 was compared between the two groups,all of which were statistically significant.The CRP level,ESR level,urine white blood cell count,urine red blood cell count,24-hour urine protein quantification,and 1-week cumulative dose of hormones in the infected group were higher than those in the non-infected group,and the differences were statistically significant(P<0.05)The WBC count [5.30(3.66,8.45)] in the infected group was not statistically significant compared with the WBC count [4.81(3.44,7.41)] in the non-infected group(P>0.05).The proportion of SLE patients with indwelling catheterization was 30.4% in the infected group and 1.5%in the non-infected group,and the proportion of SLE patients in the infected group and1.5% in the non-infected group was 14.1% in the affected group and 1.5% in the non-infected group in the hormone shock therapy group(P<0.05)。 There was no statistically significant difference between SLE na(?)ve treatment(P=0.061)and hydroxychloroquine(P=0.177).The proportion of immunosuppressants used in the infected group was higher than that in the non-infected group,and the P=0.030 was tested,which was statistically significant between the two groups.Among them,the proportion of cyclophosphamide in the infected group was 28.1%,and the proportion in the non-infected group was 11.9%,P=0.001,which was statistically significant between the two groups.Further binary logistic regression analysis showed that C-reactive protein and 1-week cumulative dose of hormones(medium and high dose hormones)were independent risk factors for urinary tract infection in SLE patients.A total of 158 pathogenic bacteria were cultured out of 124 patients with SLE and urinary tract infection,of which 62.66% were gram-negative bacteria,27.85% were gram-positive bacteria,3.16% were fungi,5.06%were atypical pathogens,and 1.27% were other pathogens.Among gram-negative bacteria,Escherichia coli(47.47%)was the most common,followed by Klebsiella pneumoniae(3.16%);Among gram-positive bacteria,Enterococcus faecis(D)group(10.12%)was the most common,followed by Staphylococcus epidermidis(6.96%).Conclusion:Gram-negative bacteria accounted for the majority of infectious agents in SLE co-infected with urinary tract infections,followed by Gram-positive bacteria.Among the gram-negative bacteria,Escherichia coli was the most common,followed by Klebsiella pneumoniae;among the gram-positive bacteria,Enterococcus faecalis(D)group was the most common,followed by Staphylococcus epidermidis.High levels of C-reactive protein and 1-week cumulative dose of hormones(moderate-to high-dose hormones)are independent risk factors for urinary tract infection in patients with SLE.Therefore,when the level of C-reactive protein in patients in clinical diagnosis and treatment is high,and larger doses of hormone therapy are used,attention should be paid to the prevention and treatment of urinary tract infection,and urine culture etiological examination should be performed in time to guide clinical diagnosis and treatment.