Infections in the lupus patient: perspectives on prevention

Abstract

Purpose of review: Infections are one of the most common causes of morbidity, hospitalization and death in patients with systemic lupus erythematosus (SLE). The aim of the review is to describe an approach to screening and prevention of infections in patients with SLE based on recent evidence.

Recent findings: This review summarizes what is known about the incidence and risk factors for infection in SLE as well as the limitations of the current literature. An approach to screening for infections such as tuberculosis and viral hepatitis is described as well as use of prophylactic agents and vaccinations.

Summary: We recommend screening for infectious comorbidities such as tuberculosis and viral hepatitis at the first clinical encounter in patients with lupus in addition to recommending pneumococcal vaccination and yearly influenza vaccination. There is currently limited evidence to support antibiotic prophylaxis for SLE patients on immunosuppressive agents to prevent penumocystis or to support screening for cytomegalovirus and further study is required. Lastly, timely antibiotic treatment in patients with lupus who are hospitalized with infectious complications is important, as delayed antibiotic treatment may be associated with increased mortality.