The clinical characteristic and outcome of skin and soft tissue infection in immunosuppressive patients with nephrotic s
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ORIGINAL ARTICLE
The clinical characteristic and outcome of skin and soft tissue infection in immunosuppressive patients with nephrotic syndrome Tianyu Hu1 · Min Wang2 · Wei Chen1 · Jinghong Zhao3 · Jiachuan Xiong3 Received: 4 November 2019 / Accepted: 16 April 2020 © Japanese Society of Nephrology 2020
Abstract Objective Skin and soft tissue infection (SSTI) is the most common of infectious diseases with high morbidity and mortality. However, the clinical characteristics of SSTI in patients with nephrotic syndrome (NS), especially in those patients who received immunosuppressive therapy, are still lacking. The present study was conducted to investigate the clinical characteristics and outcomes of SSTI in patients with NS. Methods A retrospective study was carried out among the patients diagnosed with NS and SSTI, who have priorly received or currently have been receiving immunosuppressive therapy between April 2011 and January 2019; the clinical profile included patient’s baseline characteristics, clinical presentation, microbiological findings, treatment, and prognosis. Results A total of 70 patients were analyzed. Results showed that more than half of the patients were under 35 years old, and moderate infection was the most common type of SSTI. Leg and cellulitis were the most common site of lesion and the typical clinical manifestation of SSTI, respectively. Patients in the severe infection group have a higher level of procalcitonin (PCT) and C-reactive protein (CRP), while a lower level of albumin, CD4+ T and CD8+ T cell count. Moreover, the gram-negative bacteria were the primary pathogens of SSTI in patients with NS, and Klebsiella pneumoniae were the most frequent strains isolated from those patients. Besides, patients in the mild and moderate infection groups experienced a better outcome. Conclusions Patients with NS and SSTI usually showed a satisfying outcome with proper anti-infection treatment, but severe SSTI can be life-threatening. Keywords Infection · Nephrotic syndrome · Immunosuppressive therapy · Mortality
Introduction
Tianyu Hu and Min Wang have contribute equally. * Jiachuan Xiong [email protected] 1
Department of Hospital Infection Control, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, People’s Republic of China
2
Department of Otorhinolaryngology and Head‑Neck Surgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, People’s Republic of China
3
Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, People’s Republic of China
Nephrotic syndrome (NS) is one of the most common causes of chronic kidney disease (CKD) in children and adults. The incidence of NS is about 1.15–16.9 per 100 000 in children and 3 per 100 000 in adults, respectively [1, 2], but it also depends on ethnicity and regi
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