Risk Factors and Diagnostic Markers of Bacteraemia in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Cohort Study of 176 Patients.
J Am Acad Dermatol. 2019 Jun 10;:
Authors: Koh HK, Chai ZT, Tay HW, Fook-Chong S, Choo KJ, Oh CC, Yeo YW, Koh HY, Pang SM, Lee HY
Abstract
BACKGROUND: Sepsis is the main cause of death in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
OBJECTIVES: Our aim is to identify admission risk factors predictive of bacteraemia and accompanying clinical and/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, comprising SJS (n=59), SJS/TEN overlap (n=51) and TEN (n=66). Fifty-two patients (29.5%) developed bacteraemia during hospitalisation and had poorer outcomes including higher ICU admission (p<0.0005), longer length of stay (p<0.0005) and higher mortality (p<0.0005). There were 112 bacteraemic episodes and isolates include Acinetobacter baumannii (n=31, 27.7%) and Staphylococcus aureus (n=24, 21.4%). On multivariate analysis, admission clinical factors predictive of bacteraemia include haemoglobin≤10g/dL (OR 2.4, CI 2.2-2.6), existing cardiovascular disease (OR 2.10, CI 2.0-2.3) and BSA≥10% (OR 14.3, CI 13.4-15.2). The Bacteraemia Risk Score was constructed with good calibration. Hypothermia (p=0.03) and pro-calcitonin≥1ug/L (p=0.02) concurrent with blood culture sampling were predictive of blood culture positivity.
LIMITATIONS: This is a retrospective study performed in a reference centre.
CONCLUSION: Haemoglobin≤10g/dL, existing cardiovascular disease and BSA≥10% on admission were risk factors for bacteraemia. Hypothermia and elevated pro-calcitonin are useful markers for the timely detection of bacteraemia.
PMID: 31195022 [PubMed - as supplied by publisher]