Background A 5-fold increase in the risk of death is due to infection in systemic lupus erythematosus (SLE) patients when compared to age- and sex-matched controls Pneumococcal infection (PI) has been reported to be more frequent and severe in SLE
Objectives Our study aimed to analyze the risk factors associated with the occurrence and severity of PI in SLE patients
Methods Medical records of all SLE patients and all patients admitted with PI in the Department of Internal Medicine (Bichat Hospital, Paris, France) from January 2005 to December 2014 were retrospectively reviewed. Clinical characteristics associated with PI occurrence and severity were analyzed, both in SLE and non SLE patients.
Results One hundred and ninety SLE patients (42.2+14.9 years; 87.4% females) were hospitalized over a 10-year period. PI was the reason for admission in 6 (3.2%) patients, including 5 cases of invasive infection. With a follow-up of 2112.8 years for the total cohort, incidence of invasive PI in SLE was of 236/100.000 patient-years. As compared to the incidence in general French population, invasive PI was 26 times more frequent in SLE patients. PI occurred at a younger age (43.5+14.9 versus 65.3+18.7 years, p=0.009) and was more severe, with a higher frequency of invasive infection (p<0.001) and higher need for ICU admission (p=0.015) in SLE as compared to non SLE patients. Of note, unusual PI sites, including pneumococcal endocarditis (n=1), arthritis (n=1) and peritonitis (n=1) were observed in SLE patients only. Risk factors associated with PI in SLE patients were a serum gammaglobulin level <5g/L (p=0.003) and a past history of lupus nephritis (p=0.047), only. Steroids (p<0.001) and immunosuppressive drugs (p=0.027) were associated with infection severity.
Conclusions Pneumococcal infections occur at a younger age, are more frequent and severe in SLE patients. Hypogammaglobulinemia and lupus nephritis increased the risk for PI, whereas steroids and immunosuppressive drugs were associated with infection severity only. Our study shows that SLE patients have an increased risk for invasive PI and points to the need for vaccination against streptococcus pneumoniae in SLE.
Disclosure of Interest None declared