Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Dermatology, Singapore General Hospital, Singapore.
J Am Acad Dermatol. 2019 Sep;81(3):686-693. doi: 10.1016/j.jaad.2019.05.096. Epub 2019 Jun 10.
Sepsis is the main cause of death in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
Our aim was to identify admission risk factors predictive of bacteremia and the accompanying clinical or biochemical markers associated with positive blood cultures.
A retrospective cohort study over a 14-year period (2003-2016) was performed.
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.
This is a retrospective study performed in a reference center.
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.
败血症是史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）的主要死亡原因。
本研究旨在确定入院时预测菌血症的危险因素，以及与血培养阳性相关的临床或生化标志物。
回顾性队列研究，研究时间为 14 年（2003-2016 年）。
本研究共纳入 176 例 SJS（n=59）、SJS-TEN 重叠综合征（n=51）和 TEN（n=66）患者。住院期间，52 例（29.5%）患者发生菌血症，这些患者的预后较差，包括更高的重症监护病房（ICU）入住率（P<0.0005）、更长的住院时间（P<0.0005）和更高的死亡率（P<0.0005）。共发生 112 次菌血症，分离出的病原体包括鲍曼不动杆菌（27.7%，n=31）和金黄色葡萄球菌（21.4%，n=24）。多因素分析显示，入院时存在的临床因素与菌血症相关，包括血红蛋白≤10 g/dL（比值比[OR] 2.4，95%置信区间[CI] 2.2-2.6）、存在心血管疾病（OR 2.10，CI 2.0-2.3）和体表面积受累≥10%（OR 14.3，CI 13.4-15.2）。构建了菌血症风险评分，具有良好的校准度。血培养采样时出现低温（P=0.03）和降钙素原≥1μg/L（P=0.02）与血培养阳性相关。
这是在一个参考中心进行的回顾性研究。
入院时血红蛋白≤10 g/dL、心血管疾病和体表面积受累≥10%是菌血症的危险因素。低温和降钙素原升高是及时发现菌血症的有用标志物。
