Bacteremia Associated With Active Disease, Flares, Corticosteroid Use in Systemic Lupus Erythematosus

In patients with systemic lupus erythematosus (SLE), bacteremia primarily occurs in individuals with the active disease, and it is frequently associated with severe flares and corticosteroid use, according to study results published in the Journal of Rheumatology.

The study included patients (n=3679) with SLE from the Spanish RELESSER registry. The researchers collected information from each bacteremia case, including the etiologic agent, potential sources of bacteremia, antibiogram testing, treatment, and bacteremia-related outcomes. They compared these cases with that of a control group without bacteremia, and matched for sex and age at SLE diagnosis (1 case per 6 in control group).

Results showed that there were 114 episodes of bacteremia in 83 patients, with an incidence rate of 2.7 per 1000 patient-years. The median age at the time of bacteremia was 40.5 years (range 8 to 90 years), with 88.6% of cases of bacteremia occurring in female patients.

In the patients with bacteremia, the Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index was 4 (interquartile range [IQE] 8), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 3 (IQR 4). In addition, 41% of bacteremia cases involved an SLE flare; 66% were severe.

In 64% of the bacteremia cases, the researchers identified a comorbidity. At the time of the bacteremia, 88.6% of patients received corticosteroids (68.6%, >10 mg/d) and 57.0% received immunosuppressors.

The most common cause of bacteremia was gram-negative bacilli, mostly Escherichia coli (29.8%), which caused 52.6% of the episodes. Bacteremia-related mortality was 14.0%, with recurrent bacteremia cases occurring in 27.2%.

After a multivariate analysis, the results indicated that several factors were associated with bacteremia, including elevated creatinine (odds ratio [OR], 1.31; 95% CI,1.01-1.70; P =.045), diabetes (OR, 6.01; 95% CI, 2.26-15.95; P <.001), cancer (OR, 5.32; 95% CI, 2.23-12.70; P <.001), immunosuppressors (OR, 6.35; 95% CI, 3.42-11.77; P <.001), and damage (OR, 1.65; 95% CI, 1.31-2.09; P <.001).

Reference

Rúa-Figueroa I, López-Longo FJ, Campo VD, et al. Bacteremia in systemic lupus erythematosus in patients from a Spanish registry: risk factors, clinical and microbiological characteristics, and outcomes. J Rheumatol. 2019;46(8).