Inadequate antimicrobial treatment for nosocomial infection is a mortality risk factor for systemic lupus erythematous patients admitted to intensive care unit.
BACKGROUND
Infection is a frequent cause of death in patients with systemic lupus erythematous (SLE) admitted to the intensive care unit (ICU). Complicated clinical features of SLE patients may delay or cause inadequate antimicrobial treatment. This study aimed to determine if inadequate antimicrobial treatment is an independent risk factor for mortality in SLE patients in the ICU.


METHODS
Fifty-eight SLE patients admitted to the ICU were evaluated in a retrospective analysis. Inadequate antimicrobial treatment was defined by patient receiving antibiotics > or =24 hours after the diagnostic criteria for nosocomial infection and/or the identified microorganism did not exhibit in vitro sensitivity to the antibiotics administered in the ICU.


RESULTS
Multivariate logistic regression analysis identified the risk factors. Thirty-three (56.9%) SLE patients died during their ICU stay. The nonsurvivor group (n = 33), exhibited lower platelet count (P = 0.025), prolonged hospital stay before ICU admission (P = 0.015), higher Acute Physiology and Chronic Health Evaluation II score (P = 0.015), and higher prevalence of multiple organ failure (P = 0.044) and inadequate antimicrobial treatment (P = 0.002) compared with the survivor group (n = 25). In multivariate logistic regression analysis, inadequate antimicrobial treatment was the most significant factor for mortality (odds ratio = 12.02, 95% confidence interval = 1.24-116.10, P = 0.032). Patients with prolonged hospitalization prior ICU admission had a mild risk for mortality (odds ratio = 1.06, 95% confidence interval = 1.00-1.12, P = 0.045).


CONCLUSIONS
SLE patients in the ICU receiving inadequate antimicrobial treatment or with prior prolonged hospital stay have a higher risk of mortality. Clinical efforts should ensure adequate antimicrobial treatment in SLE patients with prior prolonged hospital stay before ICU admission.
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
Po-Hao
PH
Feng
Shu-Min
SM
Lin
Chih-Teng
CT
Yu
Kuang-Hui
KH
Yu
Chien-Da
CD
Huang
Ying-Huang
YH
Tsai
Han-Pin
HP
Kuo
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents