• Po-Hao Feng, Shu-Min Lin, Chih-Teng Yu, Kuang-Hui Yu, Chien-Da Huang, Ying-Huang Tsai, and Han-Pin Kuo.
• Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
• Am. J. Med. Sci. 2010 Jul 1; 340 (1): 64-8.

IntroductionInfection 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.MethodsFifty-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.ResultsMultivariate 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).ConclusionsSLE 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.

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