Bacteremia in systemic lupus erythematosus patients from RELESSER: risk factors, clinical and microbiological characteristics and outcomes
Abstract
Objective To describe the incidence of bacteremia in a large multicentric cohort of SLE patients and their clinical characteristics and to identify risk factors.
Methods All bacteremic episodes from the RELESSER registry were included. Clinical and laboratory characteristics concerning bacteremia and SLE status, as well as comorbidities at the time of infection, were retrospectively collected. A comparison with sex- and age-matched SLE controls without bacteremia was made. A logistic regression was conducted.
Results A total of 114 episodes of bacteremia in 83 patients were included. The incidence rate was 2.7/ 1,000 patient-years. At the time of bacteremia, the median age was 40.5 (range: 8-90) years, and 88.6 % of patients were female; SELENA-SLEDAI: 4 (IQR:8); 41% had an SLE flare (66% severe); SLICC/ACR DI: 3 (IQR4). A comorbidity was recorded in 64% of cases. At the time of bacteremia, 88.6% received corticosteroids (68.6% >10mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently E. coli (29.8%), caused 52.6% of the episodes. The bacteremia-related mortality was 14% and bacteremia was recurrent in 27.2% of cases. A dose-response relationship was found between corticosteroids and bacteremia risk. In the multivariate analysis, elevated creatinine [OR 1.31 (95%CI 1.01-1.70), p=0.045], diabetes [OR 6.01(2.26-15.95), p=0.000], cancer [OR 5.32 [2.23-12.70), p=0.000], immunosuppressors (OR 6.35 (3.42-11.77), p=0.000) and damage [OR 1.65(1.31-2.09), p=0.000] were associated with bacteremia.
Conclusion Bacteremia occurred mostly in active SLE patients and was frequently associated with severe flares and corticosteroid use. Recurrence and mortality were high. Immunosuppressors, comorbidities and disease-related damage were associated with bacteremia.