Infections in outpatients with systemic lupus erythematosus: a prospective study

Abstract

The objective of this study was to assess the incidence and risk factors of infections in 200 SLE outpatients. All outpatients with active or inactive SLE without infections in the previous month were included. They were assessed every 3 months. Major infections were those requiring hospitalization and parental antibiotic therapy; minor infections required oral or topical therapy. Sociodemographic, disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), therapy and laboratory variables were evaluated. After a follow-up of 22+/-7 months, 65 (32%) patients had infections; 35% of those were major. The most common sites for infection were urinary (26%), skin (23%), systemic (12%), and vaginal (9%). At infection onset, 50 of 65 patients (77%) had disease activity, with a mean SLEDAI score of 6.1. The variables significantly associated with infection in the univariate analyses were the presence of disease activity, SLEDAI score, renal activity, prednisone dose, and IV cyclophosphamide. The only variable associated with infection in the multivariate analyses was a SLEDAI score of 4 or higher. Most infections in SLE outpatients were single, minor, non-life threatening, and associated with disease activity independently of sociodemographic and therapeutic factors.

Pneumococcal Vertebral Osteomyelitis and Psoas Abscess in a Patient with Systemic Lupus Erythematosus Disclosing Positivity of Pneumococcal Urinary Antigen Assay

“…Infectious complications are still a major cause of mor-bidity and mortality in patients with SLE (16)(17)(18). Causative pathogens of infections in lupus patients are gram-positive cocci, gram-negative bacilli, and other organisms of opportunistic infections (17,18).…”

Management of infection in systemic lupus erythematosus

“…Usually, in an outpatient setting, infections are non-life-threatening ones. Zonana-Nacach et al reported that in this scenario, infections are associated with disease activity only, independently of socio-demographic and therapeutic factors [5]. However, it is noteworthy that infection in SLE can require hospitalisation, especially when concomitant with a flare (mainly involving the kidney or central nervous system) or when therapy with steroids or cyclophosphamide is ongoing [1].…”

“…Several studies evaluated the characteristics of major infections in SLE patients requiring hospitalisation [5], *[6] and [7]. According to these studies, infections that SLE patients developed were attributed to the same pathogens as in the general population and included community-acquired pneumonia, urinary tract infection and vaginal infection, and some patients may develop tuberculosis.…”

Prevention of Infection in Lupus Patients

“…Procalcitonin (PCT) has a good negative predictive value for bacterial infection in SLE patients with active disease, with a value <0.17 ng/ml ruling out infection complicating SLE flare [4]. In SLE patients with quiescent disease, an increase in the CRP level is a preferred over PCT [7].…”

“…They include immunological disorders due to lupus and its therapy, particularly immunosuppressive and cytotoxic medications [5,6]. Lupus disease activity, measured by the SLE disease activity index (SLEDAI), is also an important risk factor for infection [7]. The risk is also dependent on the degree of immunosuppression [8][9][10].…”