194 Risk factors for bacteremia in thai patients with systemic lupus erythematosus

Abstract

Background and aims

Bacteremia significantly affects mortality rate in SLE. It characterises differently across diverse geographic area. This study aimed to identify risk factors for bacteremia in Thai SLE patients.

Methods

A retrospective case-control study recruited SLE patients who admitted between 2004 and 2014. Cases with significant bacteremia from microbiology database were matched with SLE diagnosis. Controls were SLE patients selected from the year of the matched case's hospital admission with a ratio of 1:4. The admissions for elective procedure or patients having prior bacteremia were excluded. Demography, clinical features, organ involvement, SLE disease activity score, and treatments in the 3 months prior to admission were reviewed.

Results

Among 87 episodes of bacteremia occurred in 68 SLE patients, gram negative bacteremia was commonly found in 62 episodes (69.7%). The most common organism was non-typhoidal Salmonella sp. (22 episodes, 25.3%). Common sites of infection were unknown focus, urinary tract, abdomen, and lower respiratory tract respectively. The mortality rate was 25%. Compared with 272 SLE controls, the bacteremia group had a longer SLE duration and a larger number of active major organ involvement. Active lupus nephritis, renal failure, lymphopenia, prior use of prednisolone 15 mg or more and pulse methylprednisolone increased risk for bacteremia significantly ( Table 1 ). The overall 30 day survival was 77.9% after bacteremia and the survival probability was poorer than controls ( Figure 1 ).

Conclusions

Risk for bacteremia in SLE patients comprises both SLE disease factors and treatment factors. To improve survival, early recognition and prevention strategies in the high-risk patients is crucial.