Risk factors and diagnostic markers of bacteremia in Stevens-Johnson syndrome and toxic epidermal necrolysis: A cohort study of 176 patients
Risk factors and diagnostic markers of bacteremia in Stevens-Johnson syndrome and toxic epidermal necrolysis: A cohort study of 176 patients
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DOI：
10.1016/j.jaad.2019.05.096
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发表时间：
2019-09-01
影响因子：
13.8
通讯作者：
Lee, Haur Yueh
中科院分区：
文献类型：
--
作者：
Koh, Hui Kai;Chai, Zi Teng;Lee, Haur Yueh
背景：脓毒症是史蒂文斯-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。目的：我们的目的是确定预测菌血症的入院危险因素以及伴随的与阳性血培养相关的临床或生化标志物。方法：回顾性队列研究，时间跨度为14年（2003-2016）。结果：本研究纳入176例SJS患者（n = 59）， SJS-TEN重叠（n = 51）和TEN （n = 66）。在住院期间，52名患者（29.5%）出现菌血症，其预后较差，包括重症监护病房住院率较高（P < 0.0005）、住院时间较长（P < 0.0005）和死亡率较高（P < 0.0005）。菌血症112例，分离物包括鲍曼不动杆菌（27.7%,n = 31）和金黄色葡萄球菌（21.4%,n = 24）。在多变量分析中，入院时存在的预测菌血症的临床因素包括血红蛋白= 10% （OR 14.3, CI 13.4-15.2）。构建菌血症风险评分，校正良好。低温（P = 0.03）和降钙素原>= 1 μ g/L （P = 0.02）同时采血可预测血培养阳性。局限性：这是一个在参考中心进行的回顾性研究。结论：入院时血红蛋白= 10%是发生菌血症的危险因素。低温和降钙素原升高是及时发现菌血症的有用标志。
Background: Sepsis is the main cause of death in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).Objectives: Our aim was to identify admission risk factors predictive of bacteremia and the accompanying clinical 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 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% (OR 14.3, CI 13.4-15.2). The Bacteremia Risk Score was constructed with good calibration. Hypothermia (P = .03) and procalcitonin >= 1 mu g/L (P = .02) concurrent with blood culture sampling were predictive of blood culture positivity.Limitations: This is a retrospective study performed in a reference center.Conclusion: Hemoglobin = 10% on admission were risk factors for bacteremia. Hypothermia and elevated procalcitonin are useful markers for the timely detection of bacteremia.