Should asymptomatic bacteriuria be treated in lupus nephritis?

Area of Science:

• Nephrology
• Rheumatology
• Infectious Diseases

Background:

• Systemic lupus erythematosus (SLE) patients face heightened infection risks due to disease activity and immunosuppression.
• Asymptomatic bacteriuria (ASB) is a potential trigger for SLE flares, prompting investigation into its systematic treatment.
• Limited evidence exists regarding ASB screening and treatment protocols in SLE management.

Purpose of the Study:

• To investigate the association between ASB and the incidence of infection and disease flares in lupus nephritis patients.
• To analyze infection rates and disease activity in lupus nephritis patients with and without ASB during induction therapy.

Main Methods:

• A cross-sectional study involving 37 lupus nephritis patients undergoing high-dose cyclophosphamide induction therapy.
• Patients were categorized into two groups: with ASB and without ASB.
• Urine and blood samples were collected prior to cyclophosphamide administration for analysis.

Main Results:

• Of 37 patients, 19 (51.4%) had ASB and 18 (48.6%) did not; groups were demographically balanced.
• No significant association was found between ASB and SLE disease activity index, 24-h urine protein, or leukocyte count.
• Infection rates were similar between groups (5.3% with ASB vs. 5.6% without ASB), with no statistically significant difference (p=1.000).

Conclusions:

• This study found no statistically significant link between ASB and infection occurrence or disease activity in lupus nephritis patients.
• The findings suggest that ASB may not necessitate routine treatment in this population, avoiding unnecessary antimicrobial use.
• Further research is required to definitively clarify the role of ASB in SLE and its potential impact on infection and flares.