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<p>Infection remains the leading cause of mortality in pemphigus, particularly among hospitalized patients with moderate-to-severe disease. This retrospective cohort study analyzed 102 pemphigus inpatients (mean age 52 years, female: male = 1.5:1) treated between 2017 and 2023, aiming to characterize infection patterns and identify modifiable risk factors. We observed an overall infection rate of 40.2%, with cutaneous (39%) and respiratory (20%) infections predominating. Notably, 43.9% were classified as hospital-acquired. Infection incidence increased significantly after seven hospitalization days. All infections developed after one month of stay met the classification of severe infection. Microbiological analysis identified <i>Staphylococcus aureus</i> as the predominant pathogen, followed by <i>Candida parapsilosis</i>. Pulmonary infections exhibited fungal predominance, including two cases of <i>Pneumocystis jirovecii</i> pneumonia (PJP) in high-dose corticosteroid recipients. Multivariable logistic regression identified four independent risk factors: prior immunosuppressive therapy (<i>p</i> = 0.008), disease relapse (<i>p</i> = 0.005), low albumin levels (<i>p</i> = 0.012), and systemic corticosteroid dosage (prednisone-equivalent) ≥ 1&#xa0;mg/kg per day (<i>p</i> = 0.046). In addition, prolonged disease history (<i>p</i> = 0.024) and systemic corticosteroid dosage ≥ 1&#xa0;mg/kg per day (<i>p</i> = 0.004) were risk factors for severe infection. For empirical antibiotic treatment, third-generation cephalosporin and fluoroquinolone were the most frequently used antibiotics. third-generation cephalosporins achieved 75% remission in cutaneous infections, whereas pneumonia commonly required combination therapy due to polymicrobial etiologies. Sulfamethoxazole prophylaxis correctly targeted two PJP cases. This study provides the first evidence for time-stratified infection risk management in hospitalized pemphigus cohorts, advocating intensified infection surveillance for hospitalizations exceeding 7 days. Albumin levels, corticosteroid dosing, and treatment history could be integrated into risk stratification protocols. Pathogen diversity underscores the necessity for culture-guided therapy despite empirical antibiotic utility.</p>

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Characteristics and risk factors for infection in hospitalized patients with moderate to severe pemphigus: a retrospective study of 102 patients

  • 期刊论文

  • 发表日期：

    2025年7月5日

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  • Xinyi Lu,
  • Hanlin Zhang,
  • Yuqiao Zhang,
  • Keyun Tang,
  • Hongzhong Jin

摘要

Infection remains the leading cause of mortality in pemphigus, particularly among hospitalized patients with moderate-to-severe disease. This retrospective cohort study analyzed 102 pemphigus inpatients (mean age 52 years, female: male = 1.5:1) treated between 2017 and 2023, aiming to characterize infection patterns and identify modifiable risk factors. We observed an overall infection rate of 40.2%, with cutaneous (39%) and respiratory (20%) infections predominating. Notably, 43.9% were classified as hospital-acquired. Infection incidence increased significantly after seven hospitalization days. All infections developed after one month of stay met the classification of severe infection. Microbiological analysis identified Staphylococcus aureus as the predominant pathogen, followed by Candida parapsilosis. Pulmonary infections exhibited fungal predominance, including two cases of Pneumocystis jirovecii pneumonia (PJP) in high-dose corticosteroid recipients. Multivariable logistic regression identified four independent risk factors: prior immunosuppressive therapy (p = 0.008), disease relapse (p = 0.005), low albumin levels (p = 0.012), and systemic corticosteroid dosage (prednisone-equivalent) ≥ 1 mg/kg per day (p = 0.046). In addition, prolonged disease history (p = 0.024) and systemic corticosteroid dosage ≥ 1 mg/kg per day (p = 0.004) were risk factors for severe infection. For empirical antibiotic treatment, third-generation cephalosporin and fluoroquinolone were the most frequently used antibiotics. third-generation cephalosporins achieved 75% remission in cutaneous infections, whereas pneumonia commonly required combination therapy due to polymicrobial etiologies. Sulfamethoxazole prophylaxis correctly targeted two PJP cases. This study provides the first evidence for time-stratified infection risk management in hospitalized pemphigus cohorts, advocating intensified infection surveillance for hospitalizations exceeding 7 days. Albumin levels, corticosteroid dosing, and treatment history could be integrated into risk stratification protocols. Pathogen diversity underscores the necessity for culture-guided therapy despite empirical antibiotic utility.