Infections in outpatients with systemic lupus erythematosus: a prospectivestudy

The objective of this study was to assess the incidence and risk factors of infections in 200 SLE outpatients. All outpatients with active or inactive SLE without infections in the previous month were included. They were asse ssed every 3 months. Major infections were those requiring hospitalization and parental antibiotic therapy; minor infections required oral or topical therapy. Sociodemographic, disease activity using the Systemic Lupus Erythe matosus Disease Activity Index (SLEDAI), therapy and laboratory variables w ere evaluated. After a follow-up of 22 +/- 7 months, 65 (32%) patients had infections; 35% of those were major. The most common sites for infection were urinary (26% ), skin (23%), systemic (12%), and vaginal (9%). At infection onset, 50 of 65 patients (77%) had disease activity, with a mean SLEDAI score of 6.1. Th e variables significantly associated with infection in the univariate analy ses were the presence of disease activity, SLEDAI score, renal activity, pr ednisone dose, and IV cyclophosphamide. The only variable associated with i nfection in the multivariate analyses was a SLEDAI score of 4 or higher. Most infections in SLE outpatients were single, minor, non-life threatening , and associated with disease activity independently of sociodemographic an d therapeutic factors.