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Title

MICROBIOLOGICAL PROFILE OF 67 HOSPITALIZATIONS DUE TO INFECTION IN SYSTEMIC LUPUS ERYTHEMATOUS PATIENTS

Background

Infectious complications are responsible for about 25% of deaths in patients with Systemic Lupus Erythematous (SLE). In 1998, Petri and contributors estimated that 50% of the patients with SLE will develop at least one episode of severe infection during disease follow-up. Even though risk for atypical infections is increased by chronic immunosuppression, most frequent observed infections are similar to general population. The objective of the present study is to analyze infections in a group of patients hospitalized in a tertiary hospital.

Materials and methods

Retrospective analysis of 67 hospitalization medical records from Systemic Lupus Erythematous pacients due to infections. Infection was defined by the presence of indicative signs and symptoms associated to at least one of the three following: suggestive imaging exam, visible infectious focus and/or positive biologic material cultures.

Results

Patients mean age was 34 years (+/- 13), and 89,5% of them were female, with about 7 years of diagnosis (5,0-14,0). Modified 2K SLEDAI median was 8 (1-13). Medium C-reactive protein (CRP) at admission was 35 mg/dL (13-84). Patients presented positive cultures in 35,8% of hospitalizations, being 11,9% blood cultures. Medium CRP was higher in patients with positive cultures [69 (21-168) versus 24 (13-52), p=0,022]. Most frequent infections were pneumonia, urinary tract and skin, each responsible for 20,3%. Only one case of viral and one case of fungal infection were documented. Among the microbes, non-contaminant Gram positive were the most frequent (35,3%), followed by sensible Gram negative bacilli (20,6%). Eight resistant microbes were identified: six resistant Gram negative bacilli (producers of betalactamase e carbapenemase); and two Gram positives, one meticilin resistant Staphyloccocus (MRSA), and Vancomycin Resistant Enterococci (VRE). Despite low prevalence of resident microbes, 40 (59,7%) patients received broad spectrum antibiotics.

Conclusions

The present study, in agreement with the literature, observed that community bacterial infections were more common in the sample. There is a tendency to prescribing broad spectrum antibiotics, not justified based on the epidemiology pointed by the studies. Larger prospective studies are necessary to identify the factors associated to the risk of infection by resistant bacteria, for the more rational use of antibiotics.