Bacteremia in Systemic Lupus Erythematosus in Patients from a Spanish Registry: Risk Factors, Clinical and Microbiological Characteristics, and Outcomes

Iñigo Rúa-Figueroa; Francisco J López-Longo; Víctor Del Campo; María Galindo-Izquierdo; Esther Uriarte; Julián Torre-Cisneros; Paloma Vela; Eva Tomero; Javier Narváez; Alejandro Olivé; Mercedes Freire; Eva Salgado; José Luis Andreu; Víctor Martínez-Taboada; Jaime Calvo-Alén; Blanca Hernández-Cruz; Enrique Raya; Víctor Quevedo; Lorena Expósito Pérez; Antonio Fernández-Nebro; Mónica Ibañez; Èlia Pascual-Valls; David Rúa-Figueroa; Antonio Naranjo; José M Pego-Reigosa

doi:10.3899/jrheum.180882

Bacteremia in Systemic Lupus Erythematosus in Patients from a Spanish Registry: Risk Factors, Clinical and Microbiological Characteristics, and Outcomes

J Rheumatol. 2020 Feb;47(2):234-240. doi: 10.3899/jrheum.180882. Epub 2019 Apr 15.

Authors

Iñigo Rúa-Figueroa^{1

2}, Francisco J López-Longo^{3

4}, Víctor Del Campo^{3

4}, María Galindo-Izquierdo^{3

4}, Esther Uriarte^{3

4}, Julián Torre-Cisneros^{3

4}, Paloma Vela^{3

4}, Eva Tomero^{3

4}, Javier Narváez^{3

4}, Alejandro Olivé^{3

4}, Mercedes Freire^{3

4}, Eva Salgado^{3

4}, José Luis Andreu^{3

4}, Víctor Martínez-Taboada^{3

4}, Jaime Calvo-Alén^{3

4}, Blanca Hernández-Cruz^{3

4}, Enrique Raya^{3

4}, Víctor Quevedo^{3

4}, Lorena Expósito Pérez^{3

4}, Antonio Fernández-Nebro^{3

4}, Mónica Ibañez^{3

4}, Èlia Pascual-Valls^{3

4}, David Rúa-Figueroa^{3

4}, Antonio Naranjo^{3

4}, José M Pego-Reigosa^{3

4}

Affiliations

¹ From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain. iruafer@gobiernodecanarias.org.
² I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo. iruafer@gobiernodecanarias.org.
³ From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.
⁴ I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo.

PMID: 30988123
DOI: 10.3899/jrheum.180882

Abstract

Objective: To describe the incidence of bacteremia in a large multicentric cohort of patients with systemic lupus erythematosus (SLE) and their clinical characteristics and to identify risk factors.

Methods: All bacteremic episodes from the Spanish 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: The study included 114 episodes of bacteremia in 83 patients. The incidence rate was 2.7/1000 patient-years. At the time of bacteremia, the median age was 40.5 (range: 8-90) years, and 88.6% of patients were female. The Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index was 4 [interquartile range (IQR) 8]; 41% had an SLE flare (66% severe); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 3 (IQR 4). A comorbidity was recorded in 64% of cases. At the time of bacteremia, 88.6% received corticosteroids (68.6% > 10 mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently Escherichia 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, these factors were associated with bacteremia: elevated creatinine (OR 1.31, 95% CI 1.01-1.70; p = 0.045), diabetes (OR 6.01, 95% CI 2.26-15.95; p < 0.001), cancer (OR 5.32, 95% CI 2.23-12.70; p < 0.001), immunosuppressors (OR 6.35, 95% CI 3.42-11.77; p < 0.001), and damage (OR 1.65, 95% CI 1.31-2.09; p < 0.001).

Conclusion: Bacteremia occurred mostly in patients with active SLE 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.

Keywords: BACTEREMIA; INFECTION; SYSTEMIC LUPUS ERYTHEMATOSUS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adrenal Cortex Hormones / adverse effects
Adult
Aged
Aged, 80 and over
Bacteremia / chemically induced
Bacteremia / complications*
Bacteremia / epidemiology*
Child
Comorbidity
Dose-Response Relationship, Drug
Female
Humans
Immunosuppressive Agents / adverse effects
Incidence
Logistic Models
Lupus Erythematosus, Systemic / complications*
Lupus Erythematosus, Systemic / drug therapy
Lupus Erythematosus, Systemic / epidemiology*
Male
Middle Aged
Registries*
Retrospective Studies
Risk Factors
Severity of Illness Index
Spain / epidemiology
Treatment Outcome
Young Adult

Substances

Adrenal Cortex Hormones
Immunosuppressive Agents