Severe infections in patients with lupus nephritis treated with immunosuppressants: A retrospective cohort study

Abstract Background Anaerobic infections are an important cause of bacteremia and severe Infections. Due to increasing extended spectrum β-lactamase resistance (ESBL), the treatment recommendations for anaerobic infections in Sweden have changed during the past ten years. The effects of anaerobe resistance and outcome for patients with anaerobe infections is unclear. Methods A retrospective cohort study was conducted in patients with bacteraemia due to Bacteroides species in the Region of Skåne between 2011 and 2015. Data on patients were reviewed from medical and microbiological records and we determined the factors associated with 28-day mortality using a multivariate regression model. Results Data on 454 patients were reviewed from medical and microbiological records and 389 (median age, 76 years; male, 54%) met the inclusion criteria. The 28-day all-cause mortality rate was 19% (72/389). Inadequate empirical antibiotic therapy occurred among 182 (47%) patients, and we found a trend toward that inadequate antibiotic treatment increased the 28-day mortality (P = 0.055). The frequency of bacteraemia with Bacteroides increased during the period of time and Bacteroides fragilis was the most common bacteria, 55% (212/389). The resistance against piperacillin/tazobactam was higher than in many other studies and among the different Bacteroides isolates that were resistant to piperacillin/tazobactam, Bacteroides thetaiotamicron was the most prevalent with 60% (50/83) being resistant. Piperacillin/tazobactam was the frequently used antimicrobial agent against Bacteroides infections and the utilization was increasing. We did not find any resistance among the Bacteroides isolates against metronidazole and only three isolates were resistant against carbapenems. Conclusion Anaerobe resistance is an increasing issue and especially against the most common antibiotic treatment, piperacillin/tazobactam. Early recognition and appropriate treatment is important to avoid proliferation of these increasing bacteria since inadequate treatment increased the mortality. Disclosures All authors: No reported disclosures.

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Risk factors of venous thromboembolism in patients with nephrotic syndrome: a retrospective cohort study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa134 ◽

2020 ◽

Author(s):

Kanna Shinkawa ◽

Satomi Yoshida ◽

Tomotsugu Seki ◽

Motoko Yanagita ◽

Koji Kawakami

Keyword(s):

Risk Factors ◽

Nephrotic Syndrome ◽

Cohort Study ◽

Venous Thromboembolism ◽

Lupus Nephritis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Vein Thrombosis ◽

Female Sex ◽

Increased Risk

Abstract Background Nephrotic syndrome is associated with an increased risk of venous thromboembolism (VTE). However, the risk factors of VTE in nephrotic syndrome, other than hypoalbuminemia and severe proteinuria, are not well established. Therefore we aimed to investigate the risk factors of VTE in patients with nephrotic syndrome. Methods This retrospective cohort study used data from a Japanese nationwide claims database. We identified patients ≥18 years of age hospitalized with nephrotic syndrome. Through multivariable logistic regression, we determined the risk factors of VTE in patients with nephrotic syndrome during hospitalization. Results Of the 7473 hospitalized patients with nephrotic syndrome without VTE, 221 (3.0%) developed VTE. In the VTE group, 14 (6.3%), 11 (5.0%) and 198 (89.6%) patients developed pulmonary embolism, renal vein thrombosis and deep vein thrombosis, respectively. We found that female sex {odds ratio [OR] 1.39 [95% confidence interval (CI) 1.05–1.85]}, body mass index (BMI) ≥30 [OR 2.01 (95% CI 1.35–2.99)], acute kidney injury [AKI; OR 1.67 (95% CI 1.07–2.62)], sepsis [OR 2.85 (95% CI 1.37–5.93)], lupus nephritis [OR 3.64 (95% CI 1.58–8.37)] and intravenous corticosteroids use [OR 2.40 (95% CI 1.52–3.80)] were associated with a significantly higher risk of developing VTE. Conclusions In patients with nephrotic syndrome, female sex, BMI ≥30, AKI, sepsis, lupus nephritis and intravenous corticosteroid use may help evaluate the risk of VTE.

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