Background/Purpose: This study aimed to investigate the incidence and risk factors of bloodstream infection (BSI) in patients with systemic lupus erythematosus (SLE) receiving moderate-to-high dose of glucocorticoids.

Methods: This study included 1109 treatment episodes with prolonged (≥4 weeks), moderate-to-high dose glucocorticoids (≥ 15mg/day prednisolone) in 612 patients with SLE over 14-year period. All patients were fulfilled four or more of the 1997 ACR revised classification criteria for SLE. Clinical features regarding disease activity (SLEDAI-2K), immunosuppressant use and laboratory results were collected from the electronic medical database. Baseline date was defined as the date of initiating moderate-to-high dose steroid and observation period was 1 year from the baseline date. Incidence rate and risk factors for BSI were investigated using generalized estimating equation poisson regression.

Results: During a total of 1078.64 person-years, 30 cases of BSI occurred in 27 treatment episodes, with an incidence rate of 2.78 [95% confidence interval (CI) 1.88 – 3.97] per 100 person-years. When the incidence rate was stratified by baseline steroid dose and SLEDAI-2K score, higher incidence of BSI occurred with the higher dose of baseline steroid and disease activity score. Treatment episodes with SLEDAI-2K≥20 showed remarkably high incidence rate. In the multivariable analysis, SLEDAI-2K≥20 (incidence rate ratio [IRR]: 5.54, 95% CI 2.56-11.99), cumulative prednisolone≥15mg/day for previous 6 months (IRR 2.66, 95% CI 1.36-5.22) and initial prednisolone≥60mg/day (IRR 2.52, 95% CI 1.18-5.44) were highly associated with increased risk of the BSI. The trimethoprim–sulfamethoxazole(TMP-SMX) prophylaxis was associated with a lower incidence of BSI (IRR 0.42, 95% CI 0.18 to 0.99, p=0.047).

Conclusion: In SLE patients exposed to prolonged moderate-to-high dose glucocorticoids, high disease activity and high intensity of previous and concurrent glucocorticoid use are important factors that increase the risk of BSI. The prophylactic use of TMP-SMX should be considered when initiating high dose glucocorticoids for controlling disease activity in SLE pateints.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-bloodstream-infection-in-patients-with-systemic-lupus-erythematosus-exposed-to-prolonged-moderate-to-high-dose-glucocorticoids/