Stewart Thomas Jonathan, Chan Chon-Wai Jeremy, Shah Hemali, Frew John
Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia.
School of Medicine, University of New South Wales, Kensington, NSW, Australia.
Int J Dermatol. 2025 May;64(5):830-848. doi: 10.1111/ijd.17527. Epub 2024 Oct 21.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous adverse reactions to medications characterized by keratinocyte necrosis leading to loss of protective barrier function and increased susceptibility to infection. Infection is a major cause of morbidity, and septicemia is the leading cause of mortality in this population. This systematic review and meta-analysis aimed to determine infectious complications' prevalence and risk factors in adults with SJS and TEN. This review was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Thirty-six articles describing results from 1446 cases were included. Skin infection was the most commonly diagnosed infection. The pooled prevalence of sepsis, respiratory tract infection, skin infection, and urinary tract infection was 27.3%, 21.5%, 37.5%, and 21.8%, respectively. Staphylococcus aureus was the most commonly identified organism. The overall quality of the studies was suboptimal, and the level of heterogeneity was high. The skin, bloodstream, respiratory, and urinary tracts are most commonly infected in the course of adult SJS and TEN. During hospitalization, clinicians should closely monitor and promptly investigate for these as well as several other infectious complications. More research is needed, with greater attention to the risk factors and causative organisms that cause these infections.
史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是罕见的严重药物性皮肤不良反应，其特征是角质形成细胞坏死，导致保护屏障功能丧失，感染易感性增加。感染是发病的主要原因，败血症是该人群死亡的主要原因。本系统评价和荟萃分析旨在确定成人SJS和TEN患者感染并发症的患病率及危险因素。本评价已在国际注册系统评价和荟萃分析方案平台（INPLASY）注册，并按照系统评价和荟萃分析的首选报告项目（PRISMA）报告指南进行。纳入了36篇描述1446例病例结果的文章。皮肤感染是最常诊断出的感染。败血症、呼吸道感染、皮肤感染和尿路感染的合并患病率分别为27.3%、21.5%、37.5%和21.8%。金黄色葡萄球菌是最常鉴定出的病原体。研究的总体质量欠佳，异质性水平较高。在成人SJS和TEN病程中，皮肤、血液、呼吸道和泌尿道最常受到感染。住院期间，临床医生应密切监测并及时调查这些以及其他几种感染并发症。需要开展更多研究，更加关注导致这些感染的危险因素和病原体。
