重叠综合征或中毒性表皮坏死松解症患者的血流感染发生率和定性与定量皮肤培养的预测价值：98 例回顾性观察性队列研究。

Incidence of bloodstream infections and predictive value of qualitative and quantitative skin cultures of patients with overlap syndrome or toxic epidermal necrolysis: A retrospective observational cohort study of 98 cases.

机构信息

Department of Dermatology, Assistance Publique-Hôpitaux de Paris, hôpital Henri Mondor, Créteil, France.

Department of Microbiology, Assistance Publique-Hôpitaux de Paris, hôpital Henri Mondor, Créteil, France; Université Paris-Est Créteil Val de Marne, University Paris-Est Créteil, Créteil, France.

出版信息

J Am Acad Dermatol. 2019 Aug;81(2):342-347. doi: 10.1016/j.jaad.2019.03.030. Epub 2019 Mar 16.

DOI:10.1016/j.jaad.2019.03.030

PMID:30890340

Abstract

BACKGROUND

Epidermal necrolysis (EN) involving ≥10% of the body surface area (BSA) is often complicated by bacterial infections.

OBJECTIVE

We sought to describe the epidemiology of bloodstream infections (BSIs) in EN involving a BSA ≥10% and the diagnostic performances of skin cultures for predicting the pathogen(s) isolated from BSIs.

METHODS

This retrospective single-center observational study was conducted between 2009 and 2017. All patients referred at the acute phase for EN involving a BSA ≥10% were included. All clinical and bacteriologically relevant data were collected (blood and skin cultures results, number, and severity and time of BSI). Sensitivity, specificity, and predictive values of skin cultures and impact of the bacterial inoculum were investigated.

RESULTS

Of 98 patients, 46 (46.9%) had ≥1 BSI episode during the hospital stay (BSIs were caused by Staphylococcus aureus [n = 17, 36.9%] and Pseudomonas aeruginosa [n = 17, 36.9%]). Skin cultures were concordant with blood cultures in 32 cases (71.1%). The positive and negative predictive values were 57.7% and 89.4% for S aureus and 50.0% and 80.9% for P aeruginosa, respectively. BSI increased with cutaneous inoculum of S aureus.

LIMITATIONS

This was a retrospective single-center design with a low total number of BSIs.

CONCLUSION

Skin cultures for S aureus and P aeruginosa may help predict the pathogens involved in BSIs.

摘要

背景

表皮松解坏死（EN）累及体表面积（BSA）≥10%常并发细菌感染。

目的

我们旨在描述累及 BSA≥10%的 EN 患者血流感染（BSI）的流行病学特征，以及皮肤培养对预测 BSI 分离病原体的诊断性能。

方法

这是一项 2009 年至 2017 年进行的回顾性单中心观察性研究。纳入所有在急性 EN 阶段累及 BSA≥10%的患者。收集所有临床和细菌学相关数据（血培养和皮肤培养结果、数量以及 BSI 的严重程度和时间）。研究了皮肤培养的敏感性、特异性和预测值，以及细菌接种量的影响。

结果

98 例患者中，46 例（46.9%）在住院期间发生≥1 次 BSI（BSI 由金黄色葡萄球菌[n=17，36.9%]和铜绿假单胞菌[n=17，36.9%]引起）。32 例（71.1%）皮肤培养与血培养一致。金黄色葡萄球菌的阳性和阴性预测值分别为 57.7%和 89.4%，铜绿假单胞菌分别为 50.0%和 80.9%。BSI 随着金黄色葡萄球菌皮肤接种量的增加而增加。