Clinical Analysis Of Systemic Lupus Erythematosus Complicated With Blood Flow Infection

Objective This study is aimed to evaluate the etiology,risk factors and clinical features of systemic lupus erythematosus complicated with blood stream infection,and to assess the associations with disease severity and the choice of treatment drugs.Methods 26 SLE patients with blood flow infections and 26 SLE patients without blood flow infections were consecutively enrolled.All the patients in study were hospitalized in Union Hospital of Fujian Medical University from January 2010 to June 2017,and met the American College of Rheumatology(2009)disease classification for SLE.The clinical and laboratory data of patients were analyzed by SPSS21 statistical software.Results 1.A total of 29 pathogen strains were detected in 26 septicemia patients by blood culture.Among them,14 strains of Gram-negative bacteria(48.2%);3 strains of Escherichia coli(10.3%);12 strains of Gram-positive bacteria(41.3%);6 strains of Staphylococcus aureus(20.66%);3 strains of fungi(10.3%);2 strains of new Cryptococcus cerevisiae(6.8%).2.Primary infection site: the most common site of primary infection in patients with systemic lupus erythematosus complicated with bloodstream infection was respiratory tract 46.1%,followed by skin and soft tissue 11.5%,urinary tract 7.6%,central nervous system 7.6%.3.Analysis of drug sensitivity of blood culture: Gram-negative bacteria were most sensitive to tegacyclin and meropenem,Gram-positive bacteria were most sensitive to vancomycin,teicoplanin,linazolamide,tegacycline,and fungi were most sensitive to 5-fluorocytosine.Amphotericin B,fluconazole,itraconazole and voleconazole were all sensitive.4.Therapeutic effect: Of the 26 cases of SLE complicated with bloodstream infection,19 cases were effectively treated(44.8%),7 automatically discharged cases were ineffective.In the patients with Gram-negative bacillary septicemia,10 cases were effective,3 cases were ineffective,7 cases were effective and 3 cases were ineffective.In the patients with Gram-positive bacillary bloodstream infection,7 cases were effective and 3 cases were ineffective.The treatment of 2 cases with fungal bloodstream infection was effective(66.7%),1 case was ineffective(33.3%).5.Sex,anti-dsDNA,complement C-3,immunoglobulin IgA(IgA)were not significantly different between the two groups(P > 0.05).6.Age,systemic damage,systemic lupus erythematosus activity score,daily dose of glucocorticoid,accumulation of cyclophosphamide,24 hours urine protein of white serum protein,high fever(? 39 ?,white blood cell count,neutrophil count),The erythrocyte sedimentation rate was significantly higher than that of the control group(P < 0.05).Conclusion 1.In this study,septicemia happend in SLE patients was often caused by bacterial infections,among which Gram-negative bacilli were isolated most commonly,Gram-negative bacillus that was most often isolated is Escherichia coli,Gram-positive bacteria were Staphylococcus aureus.New Cryptococcus cerevisiae were the most common pathogen of fungi infection.2.Respiratory tract infection is the most common site of septicemia,followed by skin and soft tissue infection.3.In the rational application of antibiotics,broad-spectrum antibiotics,such as,anti-Gram-negative bacteria might be the best choice,and at the same time give consideration to Gram-positive bacteria.4.Sex,anti-dsDNA,complement C-3,immunoglobulin(IgA)were not correlated with SLE complicated with blood stream infection.5.Age,systemic damage,systemic lupus erythematosus activity score,daily dose of glucocorticoid,accumulation of cyclophosphamide and 24 hours urinary albumin were risk factors for SLE complicated with blood flow infection.6.High fever(? 39 ?),high white blood cell count,high neutrophil count,high erythrocyte sedimentation rate(ESRs)and high C-reactive protein(CRP)should be the significant indications for SLE patients who were complicating with blood flow infection.