Abstract
BackgroundInfections were the primary cause of death (34.3–55.5%) in patients with pemphigus. Skin was usually the origin of infections. The study aimed to explore features and associated factors of bacterial skin infections (BSIs) in inpatients with pemphigus.MethodsOne hundred and seventy-seven inpatients with pemphigus hospitalizing from November 2014 to April 2019 were continuouslyrecruited through Peking University First Hospital’s inpatient records inpatients with pemphigus hospitalizing from November 2014 to April 2019 were continuously recruited through Peking University First Hospital’s inpatient records. Then, we retrieved the clinical and laboratory data to explore the characteristics and associated factors of BSIs.ResultsOf patients enrolled, pemphigus vulgaris (PV, n = 142) and pemphigus foliaceus (PF, n = 9) were most common, followed by pemphigus erythematosus (PE, n = 25) and pemphigus vegetans (Pveg, n = 1). Eighty-seven of 177 (49.2%) inpatients developed BSIs, and they had a longer length of stay compared with inpatients without BSIs (median: 18.9 vs. 14.1 days, p = 0.008). Staphylococcus aureus was the most common bacteria (71.3%, 62/87) and highly resistant to penicillin (91.9%, 57/62). Higher levels of anti-Dsg1 autoantibodies (> 124.2 U/mL) (p < 0.001, odds ratio [OR] = 3.564, 95% confidence interval [CI]: 1.784–7.123) and anti-Dsg3 autoantibodies (> 169.5 U/mL) (p = 0.03, OR = 2.074, 95% CI: 1.084–3.969) were underlying risk factors of BSIs when analyzed by binary regression analysis. As for Gram’s stain of bacteria, females had a lower rate of Gram-positive infections (p = 0.03). Patients using oral antibiotics (p = 0.05) had a higher rate of Gram-negative infections. Inpatients who were hospitalized in other hospitals within 2 weeks before the current admission had a higher rate of Gram-negative and co-infections (p = 0.03).ConclusionsInpatients with pemphigus had a high incidence of BSIs. Some factors were associated with the susceptibility of BSIs and bacterial species.
Highlights
Pemphigus is an autoimmune bullous disease characterized by flaccid blisters and erosions of skin/ mucous membranes [1]
Clinical features A total number of 177 inpatients were enrolled, including Pemphigus vulgaris (PV) (80.2%, 142/177), pemphigus erythematosus (PE, a subtype of pemphigus foliaceus (PF)) (14.1%, 25/177), PF (5.1%, 9/177), and pemphigus vegetans (Pveg, a subtype of PV) (0.6%, 1/177)
length of stay (LOS) was analyzed by a non-parametric test, and inpatients with bacterial skin infections (BSIs) had longer LOS compared with inpatients without BSIs
Summary
Pemphigus is an autoimmune bullous disease characterized by flaccid blisters and erosions of skin/ mucous membranes [1]. Infections are the most frequent complications of patients with pemphigus and account for 34.3–55.5% of all death [5,6,7,8]. Inpatients with pemphigus have a higher rate of serious infections than inpatients without a diagnosis of autoimmune bullous disease (50.4 vs 25.4%) [9]. The study aims to explore the features and associated factors for bacterial skin infections (BSIs), which may be helpful for the control of BSIs. Infections were the primary cause of death (34.3–55.5%) in patients with pemphigus. The study aimed to explore features and associated factors of bacterial skin infections (BSIs) in inpatients with pemphigus
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