INFECTION AND IMMUNOSUPPRESSION

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  • 1 January 1982
    • journal article
    • research article
    • Vol. 51  (201) , 1-15
Abstract
The infective complications in a group of 75 patients with immunologically-mediated disease who required high dose immunosuppression were studied. There were 22 patients with anti-glomerular basement membrane antibody disease, 19 patients with systemic lupus erythematosus, 18 with Wegener''s granulomatosis and 16 patients with other forms of systemic vasculitis. The infection rate was 3.69 infections per patient, or 0.74 infections per patient per wk of immunosuppression. Bacteria were the most common infecting organisms (76.1%); serious opportunist viral and fungal infections were less frequent (10.7%), but opportunist pneumonias were an important cause of death. Sixteen patients died (21%) and in 10 of these (62.5%) death was considered to be primarily due to infection. Analysis of 6 aspects of host susceptibility to infection (age, renal function, dose of prednisolone, cytophosphamide and azathioprine and number of plasma exchanges) revealed no single factor as predisposing to infection in the whole group, but in 23 patients who suffered severe infective complications, renal impairment and increasing doses of prednisolone were significantly associated, particularly in combination (P = 0.06). Cyclophosphamide was associated with infection only in the presence of neutropenia, which was rare (13 infections in 9 patients). The duration of plasma exchange was not related to the frequency of infection. Fifty patients needed an arteriovenous shunt to provide vascular access for hemodialysis or plasma exchange, and septicemia occurred in 13; only 2 episodes of septicemia were seen in patients without a shunt.