系统性红斑狼疮合并血流感染的危险因素及细菌学分析

Bloodstream infection in patients with systemic lupus erythematosus:risk factors and bacteriological analysis

目的明确系统性红斑狼疮(SLE)患者合并血流感染的危险因素及细菌学分布。方法收集2014年1月至2022年1月于山西白求恩医院风湿免疫科住院的SLE合并血流感染患者的临床资料、实验室检查及治疗方案。试验组共纳入SLE合并血流感染的21例患者,对照组按1∶2年龄、性别匹配随机配对42例的无血流感染的患者。分析比较两组患者人口学资料、临床和实验室检查基线特征、SLE活动性指数(SLEDAI)、并发症、激素和免疫抑制剂的使用以及感染组病原学分析资料。对单因素分析差异有统计学意义的变量纳入多因素logistic回归分析发现SLE合并血流感染的风险因素。结果21例血流感染组中,有4例(19%)为SLE初发患者。在单因素分析中,与非血流感染组相比,血流感染组中性粒细胞计数较高、淋巴细胞计数较低、血清肌酐升高、浆膜炎更多见及近3个月平均激素用量更高≥12.5 mg/d(均P<0.05),所有单因素分析有统计学差异的项目均纳入最终的多因素logistic回归分析模型,结果显示淋巴细胞计数下降(OR=13.070,95%CI:1.535~111.285,P=0.019)及浆膜炎(OR=0.208,95%CI:0.050~0.867,P=0.031)为SLE合并血流感染的风险因素。关于SLE患者血流感染细菌学分布,最常见的病原菌依次为大肠杆菌、金黄色葡萄球菌、沙门氏菌,感染来源依次为泌尿道、肺部、消化道。血流感染组3例患者死亡,1例为合并颅内感染的隐球菌感染,1例为大肠杆菌合并EB病毒感染,1例为合并脑脓肿的产单核李斯特菌感染。结论临床工作中,对于淋巴细胞减少及浆膜炎的SLE患者,如果出现发热及其他感染症状,应警惕合并血流感染,及时进行血培养及抗生素治疗,改善预后。

Objective To investigate the risk factors and bacteriological distribution of bloodstream infection in patients with systemic lupus erythematosus(SLE).Methods The clinical data,laboratory examination,and treatment of SLE patients hospitalized at the Rheumatology Department of Shanxi Bethune Hospital from January 2014 to January 2022 were collected.The patients were divided into either an experimental group or a control group based on the presence of bloodstream infection or not.The experimental group included 21 SLE patients with bloodstream infection,and the control group included 42 SLE patients without bloodstream infection that were randomly matched according to age and gender at a ratio of 1∶2.The demographic data,clinical and laboratory baseline characteristics,SLE activity index(SLEDAI),complications,hormone and immunosuppressant use,and etiological data were compared between the two groups.Multivariate logistic regression analysis was used to identify the risk factors for bloodstream infection in SLE patients.Results Of the 21 patients with bloodstream infection,4(19%)had initial SLE.In the univariate analysis,neutrophil count was higher,lymphocyte count was lower,serum creatinine was higher,serositis was more common,and average hormone dosage was higher(≥12.5 mg/d)in the past 3 months in the bloodstream infection group than in the non-bloodstream infection group(P<0.05 for all).All variables with a statistical difference in the univariate analysis were included in the final multivariate logistic regression analysis,and the results showed that decreased lymphocyte count(odds ratio[OR]=13.070,95%confidence interval[CI]:1.535-111.285,P=0.019)and serositis(OR=0.208,95%CI:0.050-0.867,P=0.031)were risk factors for bloodstream infection in SLE patients.Regarding the bacteriological distribution of bloodstream infections in 21 SLE patients,the most common pathogens were Escherichia coli,Staphylococcus aureus,and Salmonella,and the infection locations were the urinary tract,lungs,and gastrointestinal tract,respectively.Three patients in the bloodstream infection group died,including one case of Cryptococcus infection combined with intracranial infection,one case of Escherichia coli infection combined with Epstein-Barr virus infection,and one case of Listeria monocytogenes infection combined with brain abscess.Conclusion In clinical practice,for SLE patients with lymphocytopenia and serositis,if fever and other infection symptoms occur,vigilance should be raised for blood infection,and timely blood culture and antibiotic treatment should be carried out to improve the prognosis.