系统性红斑狼疮合并感染130例回顾性分析

目的 了解系统性红斑狼疮(SEE)住院患者的感染情况,探讨SLE患者感染发生的相关危险因素.方法 对2002年5月至2007年7月华山医院SLE住院患者的感染发生情况进行回顾性研究,包括感染部位及感染病原体;对病原菌的耐药情况进行分析;选择SLE患者感染的可疑危险因素,进行单因素分析和Logistic多因素分析.结果 533例SLE患者中发生感染130例,感染发生率为24.4%.1例患者因呼吸道感染死亡.SLE患者常见的感染部位依次为呼吸道(56.9%)、尿道(23.8%)及皮肤软组织(18.5%).在感染病原体构成中,细菌最常见(53.3%),以革兰阴性菌为主,其次为真菌(39.2%),两者合并感染比例高.尚有7例结核患者和10例带状疱疹患者.SLE患者感染最常见菌株为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌及白色念珠菌.细菌药敏试验结果显示耐药菌株比例较高.革兰阴性菌对头孢哌酮,舒巴坦及碳青霉烯类的敏感率较高.感染相关危险因素分析提示老年、低白蛋白血症、中度贫血及大剂量激素治疗为SLE患者感染发生的独立危险因素.结论 呼吸道及尿道为SLE患者最常见的感染部位,病原菌以革兰阴性菌多见,可选用头孢哌酮/舒巴坦或碳青霉烯类药物作为经验性抗菌治疗.

A clinical retrospective study of 130 systemic lupus erythematosus patients complicated with infections

Objective To investigate infectious complications and analyze their risk factors in patients with systemic lupus erythematosus (SLE) and provide clue for antibiotics treatment. Methods Patients with SLE admitted to our hospital between 2002 and 2007 were. reviewed, and the characteristics of their infections including the infection sites, pathogens and the drug resistance of pathogenic bacteria were investigated. The suspected risk factors of infections in patients with SLE were selectod and then analyzed by chi-square test and Logistic regression. Results The prevalence of infection in this group of patients was 24.4% (130/533). One patient died from respiratory tract infection. The common infection sites were respiratory tract (56.9%), urinary tract (23.8%) and skin (18.5%). Bacteria were the most common pathogens of infections in SLId pa-tients (53.3%), the majority of which were gram-negative bacteria. The second major pathogen was fungus (39.2%), and the third was the combination of bacteria and fungus. There were 7 patients with tuberculosis. The common strains causing infections in SLE patients were. Escheriehia coli, Klebsiella pneumonea, Pseu-domonas aeruginosa, Staphylococcus aureus and Candida albican. Antimicrobial susceptibility tests showod that the drug resistant rates increased rapidly. The gram-negative ones were sensitive to eefoperazone-sulbac-tam and carbopenems. The infection-related risk analysis suggested that the independent risk factors of infections in SLE patients included old age, hypopruteinemia, moderate anemia and high dose of eorticos-teruids treat-ment. Conclusion Those patients with infection-related risk factors should be monitored closely for infec-tions. Respiratory tract and urinary tract are the most common infectious sites in SLId patients, and gram-nega-tive bacteria are the major pathogens, so antibiotics such aa cefoperazone-sulbactam or carbopenems may be good choices before the result of antimicrobial susceptibility test information is available.