Analysis On Clinical Feature And Risk Factors Of Primary Sjogren’s Syndrome Combined With Infection

Objective To analyze the clinical feature of primary Sjogren’s syndrome(pSS)combined with infection,including infection site,distribution of pathogens and antibiotic resistance of common pathogens,and to exploring the risk factors of infection in patients with pSS.Methods In this retrospective study,197 patients with pSS admitted to the Department of Rheumatology and Immunology of the First Affiliated Hospital of Bengbu Medical College from January 2017 to July 2020 were enrolled,Clinical data were collected and all partcipants were divided into infection group(52 cases)and non-infection group(145 cases),the characteristics of general information,clinical manifestations(disease activity score),laboratory and imaging findings,etiology findings,treatment and in-hospital outcomes were investigated.The SPSS software was used for statistical analysis,and the risk factors related to infection were analyzed by binary Logistic regression step by step.Results(1)In this study,incidence of pSS patient with infection in this study was26.4%(52/197),The most common sites of infection were the respiratory tract(52.7%),followed by urinary tract(21.8%),skin and soft tissue infection and septicemia were also common,the insidences were 12.7% and 5.5%.(2)Bacteria are the most common pathogens of infection with 35 strains(62.5%),followed by 13 strains of the virus(23.3%).Gram-negative bacilli such as Escherichia coli and Klebsiella are the most common bacterial infections(35.7%).Drug resistance >50% were mainly ampicillin,ampicillin/ ampicillin sulbactam,cefazolin,ciprofloxacin,levofloxacin.Production β-broad-spectrum lactamase extended spectrumβ-lactamases,ESBLs)The detection rate of strains with ESBLs in Escherichia coli and Klebsiella pneumoniae were 66.7% and 75% respectively.(3)As for Staphylococcus aureus,the main antibiotics with resistance rate >50.0% were penicillin G,phenoxacillin,clindamycin,erythromycin,ciprofloxacin,tetracycline,etc.In this study,no Staphylococcus aureus resistant to ticacycline,linezolid and vancomycin were found.(4)The age,course of disease,serum cholesterol,triglyceride,C reactive protein,ESSDAI、ESSPRI score,degree of dryness and degree of fatigue,incidence of lung involvement and the utilization rate of glucocorticoid in the infected group were higher than those in the non-infected group(P < 0.05),and the total protein and albumin level in the infected group were lower than those in the non-infected group(P< 0.05).The infection rate of pSS patient in highly active group was significantly higher than that in the stable group and the mildly active group(P < 0.05),the patients with highly disease activity were more likely to be infected.(5)Logistic univariate regression analysis showed that age,ESSDAI score,ESSPRI score,fatigue degree,dryness degree,serum total protein,albumin,serum cholesterol,triglyceride,C reactive protein,pulmonary involvement were risk factors for primary Sjogren’s syndrome complicated with infection.Logistic multivariate regression analysis showed that ESSDAI score,dryness degree,serum triglyceride and pulmonary involvement were independent risk factors for primary Sjogren’s syndrome complicated with infection.Conclusion Patients with pSS have a high incidence of infection,The incidence of pSS patient with infection was very common in clinical work,mainly occured in the respiratory tract and urinary tract,the common pathogens are gram-negative bacilli such as escherichia coli and klebsiella.Most gram-negative bacilli showed resistant to antibiotics such as broad-spectrum penicillin,cephalosporin generation and quinolones,while staphylococcus aureus significant resistance to broad-spectrum penicillin,macrolides,tetracycline and quinolones.In the course of clinical diagnosis and treatment,relevant samples should be collected in time for pathogen biological detection and drug sensitivity test,and the treatment plan should be adjusted in time according to the clinical efficacy and drug sensitivity test results.ESSDAI score,dryness degree,serum triglyceride,lung involvement were independent risk factors for pSS with infection.Therefore,patients with high activity score of pSS,obvious dry symptoms,hyperlipidemia or lung involvement should be closely monitored for infection and timely measures should be taken to prevent infection.