Epidemiology and Microbiology of Pneumonia in Systemic Lupus Erythematosus (SLE)

Gabriela García-Guevara¹, Ricardo Ríos-Corzo², Hilda Fragoso-Loyo³, Juan Jakez-Ocampo⁴, John Hernandez-Flores², Mariana Lopez-Lopez⁵, Eduardo Carrillo-Maravilla⁶, Jose Sifuentes-Osornio² and Yemil Atisha-Fregoso⁷, ¹Internal Medicine, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico, ²Internal Medicine, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico, ³Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, ⁴Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico, ⁵Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico, ⁶Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico, ⁷Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 14, 2016

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster II: Damage Accrual and Quality of Life

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Pneumonia, remains as a main cause of mortality in patients with SLE. There are not specific guidelines for the empiric treatment in these patients. The aim of this study was to establish the epidemiological characteristics, the microbiological isolations and the rate of complications of patients with SLE and pneumonia.

Methods: We retrospectively reviewed medical records of patients with SLE (ACR criteria) and Pneumonia who attended the emergency room in a single tertiary care center, (January 2010 – March 2015). We collected laboratory and clinical data: demographics, treatment and disease activity (SLEDAI-2K). We collected isolation data from the microbiology department and from the medical record to ascertain that the isolation was considered responsible of pneumonia. Patients were followed for 30 days after discharge. A negative outcome was defined as need of mechanical ventilation (MV), septic shock or death during follow-up. Statistics. Descriptive statistics were used.

Results: We included 163 patients (121 women, 74%), who presented 194 episodes of pneumonia. At evaluation the mean ± SD age was 34.6 ± 12.4 years, time since diagnosis of SLE 7.1 ± 8.2 years and SLEDAI 2K was 8 ± 5.6. Duration of hospitalization was 10.7 ± 7.2 days. In 154 of the episodes patients were taken prednisone (mean dose 18 mg). In fifty eight of the episodes (29.8%) was possible to obtain a positive microbiology report. The isolated microorganisms are depicted in table 1. Fifty seven (29%) patients presented a negative outcome: 13 (7%) septic shock, 50 (26%) needed MV and 12 (6%) patients died.

Table 1. Isolated microorganisms in 58 pneumonia episodes in SLE patients
	n	%
Streptococccus pneumoniae	4	6.8
Pseudomonas aeruginosa	8	13.7
Aspergillus	7	12
Klebsiella pneumoniae	5	8.6
Methicillin-sensitive Staphylococcus aureus	5	8.6
Methicillin-resistant Staphylococcus aureus	4	6.8
E. coli	4	6.8
Strepnotrophomonas	3	5.1
Enterococcus	2	3.4
Moraxella	2	3.4
S. epidermidis	2	3.4
H.parainfluenza	2	3.4
Enterobacter cloacae	2	3.4
Acinetobacter	2	3.4
Mycobacterium tuberculosis	1	1.7
Streptococcus agalactiae	1	1.7
Candida albicans	1	1.7
H. influenza	1	1.7
P. jirovecci	1	1.7
Serratia	1	1.7
TOTAL	58	100

Conclusion: In this study, a high proportion of patients with SLE and pneumonia presented a negative outcome. With an acceptable percentage of episodes with microbiological isolation, we identified a very high incidence of atypical microorganisms, this must be taken into account for empirical antibiotic selection in these patients.

Disclosure: G. García-Guevara, None; R. Ríos-Corzo, None; H. Fragoso-Loyo, None; J. Jakez-Ocampo, None; J. Hernandez-Flores, None; M. Lopez-Lopez, None; E. Carrillo-Maravilla, None; J. Sifuentes-Osornio, None; Y. Atisha-Fregoso, None.

To cite this abstract in AMA style:

García-Guevara G, Ríos-Corzo R, Fragoso-Loyo H, Jakez-Ocampo J, Hernandez-Flores J, Lopez-Lopez M, Carrillo-Maravilla E, Sifuentes-Osornio J, Atisha-Fregoso Y. Epidemiology and Microbiology of Pneumonia in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/epidemiology-and-microbiology-of-pneumonia-in-systemic-lupus-erythematosus-sle/. Accessed .

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