Analysis Of Pathogens Distribution,Drug Resistance And Risk Factors In Patients With Systemic Lupus Erythematosus Complicated By Infection

Objective:To explore the individual regimen for the prevention and treatment of infections complicated with systemic lupus erythematosus (SLE) and importance of rational use of antibiotics by investigating the risk factors of infections, pathogens distribution and antibiotic resistance patterns in patients with SLE complicated by infection.Methods:372 patients with SLE admitted to the department of rheumatology and immunology in Anhui Provincial Hospital from January 2012 to December 2014 were enrolled. Clinical data were collected and all participants were divided into infection group (n=105) and non-infection groups (n=267). All the pathogens were separated and identified with MicroScan WALKWAY 40 system. Drug sensitivity test was performed by K-B paper disk diffusion method. The drug-resistibility were analysed with WHONET 5.6 software. SPSS 17.0 was used for the statistical analysis to screen the risk factors.Results:1) Totally,133 times of infection occurred in 105 SLE patients at various sites with 148 strains pathogens identified. The most common sites in all cases were respiratory tract infections (42.9%) and urinary infections (22.5%). The top six pathogens were Escherichiacoli, Staphylococcus aureus, Coagulase negative staphylococci (CNS), Acinetobacter bau-manmii, Pseudomonas aeruginosa and Klebsiella pneumoniae.2) The detection rate of methicillinresistant Staphylococcusarueus (MRSA), methicillin-resistant coagulase negative staphylococci (MRCNS), extended spectrum P-lactamases (ESBLs), extensively drug resistant (XDR), Acinetobacter Baumanni were 76.5%,80.0%,62.5% and 36.4% respectively. The drug resistance rates of gram-negative bacteria to ampicillin, cefazolin, ceftriaxone, fluoroquinolones and sulfanilamides were equal to or higher than 50.0%. There were 9 cases of death including 6 cases of mixed infections,5 cases of deep fungal infections, and 1 case of Klebsiella pneumoniae with pan drug-resistant (PDR).3) Univariate analysis demonstrated that the days of average hospital stay, multi-system damage (≥3 systems involved), SLE disease activity index, serum level of albumin and complement 3, C-reactive protein level (>30 mg/L), the mean daily dose of prednisone correlated with complicated infection in SLE respectively. Multivariate logistic regression analysis revealed that excessively long hospital stay (≥14 days), multi-system damage, SLE disease activity index(≥10 pionts), low level of albumin (<30g/L), C- reactive protein level (>30 mg/L), high dose prednisone (>15 mg/d) were independent risk factors of SLE complicated by infection.Conclusion:1) Patients with SLE are susceptible to infections. The major pathogen is gram-negative bacillus. Respiratory tract is the most offen infection site.2) Broad spectrum infection of complex pathogen and extensive resistance exist in SLE patients with infection. The supervision and administration of the reasonable selection of anti-biotics should be strengthened according to drug sensitivity test to prevent further development and spread of resistant bacteria.3) Long hospitalization time (≥14 days), multi-system damage (≥3 systems involved), SLE disease activity index, (≥10 pionts), low level of albumin (<30 g/L), C reactive protein level (>30 mg/L), high-dose corticosteroid are independent risk factors for complicated infection in SLE. Effective intervention measures should be taken according to the clinical characteristics and risk factors above to reduce the incidence of infection in patients with SLE.