Background Infection is a major source of morbidity and mortality in patients with SLE. The prevalence of infection in SLE is different in various countries and is due to many factors.
Objectives The aim of our study was to evaluate the incidence of various infections in Iranian SLE patients and its contribution to mortality during a 21 years period (1974–97).
Methods We evaluated retrospectively 1165 patients for 21 years. For each patient 266 parameters were systemically checked. Each episode of infection was evaluated according to the organic involvement, type of infection and the infective agent, presence of steroid therapy.
Results During this 21 years period 393 infection episodes were noted in 224 patients. The total follow-up time was 820 years (mean: 3.66). The mean interval between the beginning of the illness and the occurrence of the infectious episode was 3.4 years. Urinary tract infection (UTI) was the most frequent (24.9%). The UTI was seen in 9.3% of patients. The most frequent bacteria was Escherichia coli (68.4% of UTI). Pulmonary infections were seen in 11.9% of infection cases. In infectious pneumonia, 72.2% was due to Pneumococci. Septic arthritis was seen in 17 cases (4.3% of all infections) and Osteomyelitis in 5 cases (1.3%). The most frequent bacteria for musculoskeletal infections were Salmonella. Soft tissue infections (abscesses, cellulitis, infectious ulcer and infectious lymphadenitis) were seen in 67 cases (17%). The most frequent bacteria were Staphylococcus aureus. Septicemia was seen in 64 cases (16.3%) of patients. The most frequent bacteria were salmonella. The mean steroid dose in patients who died of infection was 48.6 mg/day versus 25.3 mg in others (P < 0.0001). To determine the effectivity of simple laboratory tests in early diagnosis of severe infections, patients were divided into three groups according to the severity of their illness. Severe infections were accompanied with higher levels of ESR (P = 0.0005), CRP (P = 0.00001) and serum creatinine (P = 0.00001) and lower levels of serum complement (P = 0.006) while Anti-DNA and active urinary sediment were not among differentiating factors. There was a significant increase in WBC count in severe infections when steroid dose was below 40 mg/day (P < 0.0001 versus P < 0.4 when the steroid dose was more than 40 mg).
Conclusion UTI was the most common infection and E. coli was the most frequent infective organism. Apart lower UTI, soft tissue infections, sepsis, and pulmonary infections were the commonest infections while S. aureus and salmonella were the most common agents. Moreover, high dose of steroids is a significant predisposing factor for infections as mentioned in other published studies. A high WBC count, raised CRP and ESR can be helpful for the diagnosis of an infection with organisms such as Salmonella, Staphylococcus, Pseudomonas or Candida albicans.
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