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Patients With Lupus At High Risk of Urinary Tract Infections
A DGReview of :"Urinary tract infections and lupus erythematosus"
Annals of the Rheumatic Diseases (ARD Online)
04/12/2004
By Jeanne Lenzer
Patients with lupus erythematosus are at higher risk of developing urinary tract infections (UTIs) than is the general population, according to a 1-year prospective study.
Infections are a major cause of morbidity and mortality in patients with lupus erythematosus, with an incidence of 50 to 150 episodes per 100 patients per year, write Carmen Hidalgo-Tenorio, MD, and colleagues, Systemic Autoimmune Diseases Unit, Internal Medicine Service, "Virgen de las Nieves" University Hospital, Granada, Spain. Previous studies found infection to be the leading cause of death in lupus patients and a leading cause of hospital admission in this population.
To determine the prevalence, risk factors and causative microorganisms associated with UTI, Dr. Hidalgo-Tenoro and colleagues in the Virgen de las Nieves Research Group conducted a 1-year study that enrolled 81 patients with lupus and 86 controls.
Results show a prevalence of UTI of 36% in the lupus group and 9% in the control group. The lupus group had 56 UTI episodes compared to 9 episodes among controls. In addition, there were 11 cases of complicated UTI in the lupus group - 2 of these required hospital admission - while there were no such cases among controls.
Risk factors associated with development of UTI were age (P = .002), prior UTI (P = .0001) and hospital admission for UTI (P = .002) and thrombocytopenia (P = .02). Multiple tests of autoantibodies and complement failed to show any substantial correlation with UTI except for antinuclear antibody >1/80 IU/mL (P = .022). Patients with UTIs were also more likely to have leucopenia (P = .093) and weekly treatment with methotrexate (P = .03).
The researchers found no association between the onset of UTI and use of corticosteroids in this cohort. Escherichia coli was the most common causative microorganism in lupus patients (60%), a similar rate as has been reported in other studies.
The authors recommend empirical treatment of patients with lupus who present with cystitis using nitrofurantoin or fosfomycin on an outpatient basis. They also suggest that patients with pyelonephritis be treated with a third-generation cefalosporin and/or gentamicin.
Ann Rheum Dis 2004;63:4:431-437.
"Urinary tract infections and lupus erythematosus"
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