Comparative Analysis Of Pathogen Distribution And Drug Resistance Of Three Common Rheumatic Diseases With Infection

Background Rheumatic diseases(RD)are mostly chronic diseases,among which there are three common rheumatic diseases,such as systemic lupus erythematosus(SLE),rheumatoid arthritis(RA),and ankylosing spondylitis(AS).Patients need to take hormones or immunosuppressive drugs for a long time,and are prone to secondary infections.Clinically,commonly used monitoring indicators such as White blood cell count(WBC)and body temperature cannot well distinguish patients with rheumatic diseases from disease activity and complicated infection.In order to explore the distribution of pathogenic bacteria and drug resistance in patients with different rheumatic diseases co-infection and observe the relevant laboratory examination indexes of patients with rheumatic diseases co-infection,this study is carried out.Objective To observe systemic lupus erythematosus(SLE),rheumatoid arthritis(RA)and ankylosing spondylitis(AS)patients with infection of pathogenic bacteria distribution,and analyze the infection of pathogen resistance,in order to help patients with rheumatic disease infection in early diagnosis,formulate rational drug use,so as to improve the cure rate of patients with rheumatic disease infection.Method A total of 67 patients with SLE,RA and AS co-infection confirmed in Henan Provincial People's Hospital from January 2016 to August 2019 with complete clinical data were collected as the infection group,among which 29 patients were SLE,21 patients were RA and 17 patients were AS.The control groups matched the infected groups with a 2:1 ratio,among which 58 patients with SLE,42 patients with RA,and 34 patients with AS were randomly stratified from non-infected patients hospitalized during the same period.To collect information on the distribution of systemic infection sites in patients with SLE,RA and AS,such as respiratory system infection and urinary system infection,and the pathogenic bacteria causing infections in different sites(the repeated isolates from the same sites of the same patients were removed)and the results of antimicrobial susceptibility test.Collection of SLE,RA,AS each infection group and control group in patients with clinical data,such as gender,age,course of the disease,hospitalization days,laboratory examination indexes such as white blood cell,C-reactive protein,erythrocyte sedimentation rate,procalcitonin,etc.The bacterial resistance monitoring software WHONET5.6 system was used to analyze the species distribution and drug resistance of the infected strains,and SPSS24.0 was used for statistical analysis.Result(1)SLE combined with infection site is mainly characterized by urinary system,accounting for 32.4%(12/37),followed by respiratory system,skin and soft tissue system,blood circulation system,central nervous system,osteoarticular system.RA combined with infection site is mainly characterized by respiratory system,accounting for 42.9%(12/28),followed by urinary system,osteoarticular system,blood circulation system,skin and soft tissue system,digestive system.AS combined with infection site is mainly characterized by osteoarticular system,accounting for 30.0%(6/20),followed by urinary system,blood circulation system,respiratory system,skin and soft tissue system,digestive system.(2)Incidence of bone joint system infection was statistically significant differences in different infection groups(P<0.05).Further paired comparison was conducted,the infection rate of bone and joint system in the SLE infection group(2.7%)was lower than that in the AS infection group(30.0%).Corrected by Bonferroni,P=0.006,with statistically significant differences.(3)37 strains of pathogenic bacteria were detected in the SLE infection group,25 strains in the RA infection group and 23 strains in the AS infection group.A total of 85 strains of pathogenic bacteria were isolated from the co-infection of three rheumatic diseases.The top five pathogens were Escherichia coli,Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa and Staphylococcus aureus.(4)In the infection groups,Staphylococcus aureus drug resistance rate of > 50.0% mainly include Penicillin,Oxacillin,Clindamycin,Erythromycin,etc.Escherichia coli,Acinetobacter baumannii,Klebsiella pneumoniae drug resistance rate of > 50.0% mainly include Fluoroquinolones,Ampicillin,Cefazolin,Cefuroxime,Cefotaxime and Trimethoprim/Sulfamethoxazole,etc.The drug resistance of Pseudomonas aeruginosa to antibiotics was less than 50.0%.(5)The positive rate of methicillin-resistant Staphylococcus aureus(MRSA)in the infection group was 62.5%;the Extended Spectrum Beta Lactamases(ESBLs)strain was prevalent in Escherichia coli and Klebsiella pneumoniae,with positive rates of 93.3% and 66.7%,respectively.There were no statistically significant differences in the detection rate of ESBLs-producing Escherichia coli and Klebsiella pneumoniae in the three rheumatic infection groups(P > 0.05).(6)PCT level of the three rheumatic infection groups was higher than that of the control groups,with statistically significant difference(P < 0.05).Conclusion Gram-negative bacilli are the main pathogenic bacteria in patients with three commom rheumatic diseases,some bacteria to antimicrobial resistance in severe cases,and the drug should be used reasonably according to the result of drug sensitivity.