Spectrum of infections and outcome among hospitalized South Africans with systemic lupus erythematosus

Our aim was to determine reasons for admission, the prevalence and spectrum of infections, and the outcomes in a multiethnic cohort of hospitalized systemic lupus erythematosus (SLE) patients in Durban, South Africa. We reviewed the records of hospitalized SLE patients seen over a 79-month period; the demographic data, clinical manifestations, laboratory findings, reasons for admission, nature of infection, and outcome were recorded. Our 167 patients, comprising 59.3 % Indians, 33.5 % African Blacks, 5.4 % Coloreds, and 1.8 % Whites, had 327 admissions. Active disease and infections accounted for 218 (66.7 %) and 115 (35.2 %) admissions respectively, with 58 (17.7 %) due to both active disease and infection. Features of active disease were mucocutaneous 33.0 %, hematological 30.3 %, renal 28.9 %, and vasculitis 27.1 %. Overall, 83 patients (49.7 %) had 155 infections; pneumonia (36.8 %), cutaneous sepsis (18.1 %), tuberculosis (13.5 %), urinary tract infections (12.9 %), and septicemia (7.1 %) were the most common. The organisms commonly isolated were Staphylococcus aureus 25.4 %, Escherichia coli 20.3 %, and Klebsiella species and Mycobacterium tuberculosis in 13.6 % each. Serositis (odds ratio (OR) = 2.7, p = 0.005) and seizures (OR = 4.8, p = 0.007) were associated with increased risk of infection. Twenty-four (14.4 %) patients died from infection and active disease; the patients who died had higher SLEDAI scores (p = 0.02) and longer duration of hospitalization (p = 0.03) but no significant associations on multiple logistic regression analysis. Bacterial infections, including tuberculosis, are common in SLE, and they are a major cause of mortality.