Risk factors and diagnostic markers of bacteremia in Stevens-Johnson syndrome and toxic epidermal necrolysis: A cohort study of 176 patients - 15/08/19
Abstract |
Background |
Sepsis is the main cause of death in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
Objectives |
Our aim was to identify admission risk factors predictive of bacteremia and the accompanying clinical or biochemical markers associated with positive blood cultures.
Methods |
A retrospective cohort study over a 14-year period (2003-2016) was performed.
Results |
The study included 176 patients with SJS (n = 59), SJS-TEN overlap (n = 51), and TEN (n = 66). During hospitalization, bacteremia developed in 52 patients (29.5%), who experienced poorer outcomes, including higher intensive care unit admission (P < .0005), longer length of stay (P < .0005), and higher mortality (P < .0005). There were 112 episodes of bacteremia, and isolates included Acinetobacter baumannii (27.7%, n = 31) and Staphylococcus aureus (21.4%, n = 24). On multivariate analysis, clinical factors present at admission that were predictive of bacteremia included hemoglobin ≤10 g/dL (odds ratio [OR] 2.4, confidence interval [CI] 2.2-2.6), existing cardiovascular disease (OR 2.10, CI 2.0-2.3), and body surface area involvement ≥10% (OR 14.3, CI 13.4-15.2). The Bacteremia Risk Score was constructed with good calibration. Hypothermia (P = .03) and procalcitonin ≥1 μg/L (P = .02) concurrent with blood culture sampling were predictive of blood culture positivity.
Limitations |
This is a retrospective study performed in a reference center.
Conclusion |
Hemoglobin ≤10 g/dL, cardiovascular disease, and body surface area involvement ≥10% on admission were risk factors for bacteremia. Hypothermia and elevated procalcitonin are useful markers for the timely detection of bacteremia.
Le texte complet de cet article est disponible en PDF.Key words : adverse drug reactions, bacteremia, diagnostic markers, microbiology, risk factors, sepsis, Stevens-Johnson syndrome, toxic epidermal necrolysis
Abbreviations used : BRS, BSA, CI, CRP, ICU, OR, SCORTEN, SJS, TEN
Plan
| Dr Koh and Dr Chai contributed equally to this study. |
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| Funding sources: None. |
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| Conflicts of interest: None disclosed. |
Vol 81 - N° 3
P. 686-693 - septembre 2019 Retour au numéro
Article précédent
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