SAT0197 INCIDENCE AND OUTCOME OF NON-TYPHOID SALMONELLA BACTEREMIA IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN COMPARISON WITH RHEUMATOID ARTHRITISAND PRIMARY SJÖGREN’S SYNDROME
Authors: Cheng-Hsun Lu, LI Ko-Jen, Cheng-Han Wu, Song-Chou Hsieh
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Non-typhoid Salmonella (NTS) infection is an important problem in patients with systemic lupus erythematosus (SLE) [1, 2]. However, less is known about the incidence rate (IR) for NTS bacteremia. <h3>Objectives:</h3> To evaluate the IR of NTS bacteremia in patients with SLE, in comparison to rheumatoid arthritis (RA) and primary Sjögren's syndrome (SjS), and by comparison with other Gram-negative bacilli (GNB) bacteremia including Escherichia coli (E. coli) and Pseudomonas aeruginosa (PsA). Furthermore, to access the survival outcome after NTS bacteremia. <h3>Methods:</h3> In this single-center retrospective cohort study, we analyzed the registry of catastrophic illnesses database for patients fulfilled the criteria of SLE, RA, and SjS in National Taiwan University Hospital. The patients aged over 20 years, with adequate follow-up during January 1, 2008 to December 31, 2017 were included. Only new episodes of positive blood cultures during the observation period were taken into analysis. Cox proportional hazards regression model was applied for calculating the incidence rate ratio (IRR) of bacteremia between different diseases, and the hazard ratio (HR) of mortality. <h3>Results:</h3> This study included 5953 patients. NTS bacteremia happened in 33 cases, among which 27 (81.8%) were group D1 and 4 (12.1%) were group B Salmonella. The baseline characteristics, IR of each GNB bacteremia, and the IRR adjusted for age, sex, diabetes mellitus (DM) as well as chronic kidney disease (CKD) are shown in Table 1. Compared to patients with RA, the IRR for NTS bacteremia was highest in SLE. The IRR for E. coli bacteremia in patients with SLE also increased in comparison with RA, although not as high as for NTS bacteremia. When compared to SjS, patients with SLE still had an elevated IRR of 3.52 (95% CI: 1.29–9.63, <i>p</i>=0.014) for NTS bacteremia. In SLE patients, DM increased the IR for NTS bacteremia (IRR: 4.43, 95% CI: 1.71–11.43, <i>p</i>=0.002; adjusted for age and sex). In the 33 cases with NTS bacteremia [male: 21.2%; age: 49.0 (37.9–64.2) years], the median observation time to event was 11.1 (IQR, 3.0–38.1) months. No recurrent bacteremia was found. There were 14 (42.4%) deaths, and 7 (21.2%) died within 60 days after NTS bacteremia. The median time to all-cause mortality was 54 (IQR, 17–153) days. In survival analysis, an abnormal body mass index (BMI, normal ≥18.5 and &lt;24) at the onset of bacteremia had a crude HR of 6.20 (95% CI: 1.64–23.52, p=0.007). The diagnosis of SLE, age, gender, DM, CKD, levels of C-reactive protein and white blood cell count did not significantly increase HR. <h3>Conclusion:</h3> Among the GNB bacteremia, patients with SLE were especially susceptible to NTS bacteremia when compared to RA and SjS. DM was a risk factor. The mortality rate after NTS bacteremia was high, and an abnormal BMI may predict it. <h3>References</h3> [1] Green L, Vinker S. Recurrent salmonella sepsis with different species in a systemic lupus erythematosus patient. Clin Rheumatol. 1996Jan; 15(1):72-74. [2] Huang CF, Chen PL, Liu MF, Lee CC, Lee NY, Chang CM, et al. Nontyphoidal Salmonella bacteremia in patients with connective tissue diseases. J Microbiol Immunol Infect. 2012Oct; 45(5):350-355. <h3>Disclosure of Interests:</h3> None declared