Department of Dermatology, The First Affiliated Hospital of GuangZhou Medical University, Guangzhou, Guangdong, China.
Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
PeerJ. 2024 Jul 11;12:e17701. doi: 10.7717/peerj.17701. eCollection 2024.
Atopic dermatitis (AD), psoriasis, and drug reactions associated with erythroderma are frequently complicated by infections. However, bloodstream infection (BSI) have received less research attention.
This study aimed to investigate the clinical characteristics and risk factors associated with BSI in patients with erythroderma.
A retrospective analysis was conducted on 141 erythroderma cases. Eleven cases were identified as having BSI. Clinical records of both BSI and non-BSI groups were reviewed and compared.
BSI was diagnosed in 7.80% (11/141) of erythroderma cases, with a breakdown of 7.14% in AD, 2.00% in psoriasis, and 17.14% in drug reactions. Notably, all positive skin cultures (7/7) showed bacterial isolates concordant with blood cultures. Univariate logistic regression analysis revealed several significant associations with BSI, including temperature (≤36.0 or ≥38.5 °C; odds ratio (OR) = 28.06; < 0.001), chilling (OR = 22.10; < 0.001), kidney disease (OR = 14.64; < 0.001), etiology of drug reactions (OR = 4.18; = 0.03), albumin (ALB) (OR = 0.86; < 0.01), C-reaction protein (CRP) (OR = 1.01; = 0.02), interleukin 6 (IL-6) (OR = 1.02; = 0.02), and procalcitonin (PCT) (OR = 1.07; = 0.03). Receiver operating characteristic (ROC) curves demonstrated significant associations with ALB ( < 0.001; the area under curve (AUC) = 0.80), PCT ( = 0.009; AUC = 0.74), and CRP ( = 0.02; AUC = 0.71).
Increased awareness of BSI risk is essential in erythroderma management. Patients with specific risk factors, such as abnormal body temperature (≤36.0 or ≥38.5 °C), chilling sensations, kidney disease, a history of drug reactions, elevated CRP (≥32 mg/L), elevated PCT (≥1.00 ng/ml), and low albumin (≤31.0 g/L), require close monitoring for BSI development.
特应性皮炎（AD）、银屑病和伴发红皮病的药物反应常并发感染。然而，血流感染（BSI）受到的关注较少。
本研究旨在探讨红皮病患者发生 BSI 的临床特征和相关危险因素。
对 141 例红皮病患者进行回顾性分析，其中 11 例被诊断为 BSI。回顾并比较了 BSI 组和非 BSI 组的临床记录。
BSI 发生率为 7.80%（11/141），AD 为 7.14%，银屑病为 2.00%，药物反应为 17.14%。值得注意的是，所有阳性皮肤培养物（7/7）均显示与血培养一致的细菌分离株。单因素 logistic 回归分析显示，BSI 与以下因素显著相关：体温（≤36.0 或≥38.5°C；比值比（OR）=28.06；<0.001）、发冷（OR=22.10；<0.001）、肾脏疾病（OR=14.64；<0.001）、药物反应病因（OR=4.18；=0.03）、白蛋白（ALB）（OR=0.86；<0.01）、C 反应蛋白（CRP）（OR=1.01；=0.02）、白细胞介素 6（IL-6）（OR=1.02；=0.02）和降钙素原（PCT）（OR=1.07；=0.03）。受试者工作特征（ROC）曲线显示与 ALB（<0.001；曲线下面积（AUC）=0.80）、PCT（=0.009；AUC=0.74）和 CRP（=0.02；AUC=0.71）显著相关。
在红皮病管理中，提高对 BSI 风险的认识至关重要。对于具有特定危险因素的患者，如体温异常（≤36.0 或≥38.5°C）、发冷、肾脏疾病、药物反应史、CRP（≥32mg/L）升高、PCT（≥1.00ng/ml）升高和白蛋白（≤31.0g/L）降低，需要密切监测 BSI 的发生。
