Long-term outcome and short-term survival of patients with systemic lupus erythematosus after bacteraemia episodes: 6-yr follow-up
Long-term outcome and short-term survival of patients with systemic lupus erythematosus after bacteraemia episodes: 6-yr follow-up
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DOI：
10.1093/rheumatology/ken196
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发表时间：
2008-09-01
期刊：
影响因子：
5.5
通讯作者：
Huang, J. -L.
中科院分区：
文献类型：
--
作者：
Chen, M. -J.;Tseng, H. -M.;Huang, J. -L.
目标。描述SLE患者菌血症的性质，并确定这些患者的短期生存和长期预后。2000 ~ 2005年在某高等教育医疗中心定期随访的1442例SLE患者的病历分析。在1442例SLE患者中，240例患者（17%）至少发生一次菌血症发作，对应的发病率为92.7例/1000例住院患者。自SLE诊断以来，我们患者的总生存率为5年92%，10年86%，15年79%。然而，在一次菌血症发作后，30天存活率降至76,360天存活率降至67%。在336例菌血症发作中，167例为社区获得性（49.7%），169例为医院获得性（50.3%）。金黄色葡萄球菌是导致革兰氏阳性菌血症的主要原因。革兰氏阴性菌中以非伤寒沙门氏菌和大肠杆菌最为常见。社区获得性沙门氏菌和链球菌血症比医院感染更常见。克雷伯氏菌和不动杆菌对医院获得性菌血症的影响明显高于社区获得性菌血症。感染不动杆菌、克雷伯菌和假单胞菌的患者14天生存率较低（分别为71.4%、55.6%和42.9%）。在SLE患者中，菌血症发作与不良的长期预后相关。细菌种类显著影响短期存活率。因此，当怀疑有菌血症的SLE患者开始经验性抗生素治疗时，我们建议使用对假单胞菌、克雷伯氏菌、不动杆菌、金黄色葡萄球菌和大肠杆菌有效的抗生素。
Objective. To describe the nature of bacteraemia in SLE patients and determine the short-term survival and long-term outcome of these patients.Methods. Analysis of the medical records of 1442 SLE patients who were regularly followed up in a tertiary teaching medical centre from 2000 to 2005.Results. Among 1442 SLE patients, 240 patients (17%) developed at least one episode of bacteraemia, corresponding to an incidence of 92.7 cases/1000 hospital admissions. Since SLE diagnosis, the overall survival of our patients was 92% at 5 yrs, 86% at 10 yrs and 79% at 15 yrs. However, after one episode of bacteraemia, the survival decreased to 76 at 30 days and 67% at 360 days. Of the 336 episodes of bacteraemia, 167 were community-acquired (49.7%) and 169 were nosocomial (50.3%). Staphylococcus aureus was the leading cause of Gram-positive bacteraemia. Among Gram-negative bacteria, non-typhoidal Salmonella and Escherichia coli were the most common species. Community-acquired Salmonella and Streptococcus bacteraemia were more common than nosocomial infections. Klebsiella and Acinetobacter spp. were significantly more responsible for nosocomial than community-acquired bacteraemia. Patients infected with Acinetobacter, Klebsiella or Pseudomonas had lower probabilities of 14-day survival (71.4, 55.6, 42.9%, respectively).Conclusions. Among SLE patients, an episode of bacteraemia was associated with an unfavourable long-term outcome. The bacterial species significantly influenced short-term survival. Therefore, when empiric antibiotic therapy is initiated in SLE patients who are suspected of bacteraemia, we suggest use of antibiotics that are effective against Pseudomonas, Klebsiella, Acinetobacter, S. aureus, and E. coli.