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Haemoglobin ≤10 g/dL, CVD on admission predict risk of bacteraemia in SJS, TEN

25 Aug 2019

Cardiovascular disease (CVD), haemoglobin ≤10 g/dL and body surface area involvement ≥10 percent on admission increase the risk of bacteraemia in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), reports a study.

Hypothermia and elevated procalcitonin appear to be useful for the timely detection of bacteraemia, the investigators said.

This study included 176 patients with SJS (n=59), SJS-TEN overlap (n=51) or TEN (n=66), of which 52 (29.5 percent) developed bacteraemia during hospitalization. These patients experienced poorer outcomes, such as higher intensive care unit admission (p<0.0005), longer length of stay (p<0.0005) and higher mortality (p<0.0005).

A total of 112 episodes of bacteraemia occurred, with isolates including Acinetobacter baumannii (27.7 percent; n=31) and Staphylococcus aureus (21.4 percent; n=24).

Multivariate analysis revealed that haemoglobin ≤10 g/dL (odds ratio [OR] 2.4, 95 percent CI, 2.2–2.6), existing CVD (OR, 2.10, 2.0–2.3) and body surface area involvement ≥10 percent (OR, 14.3, 13.4–15.2) at admission were risk factors for bacteraemia. The Bacteraemia Risk Score was constructed with good calibration.

Moreover, blood culture positivity was predicted by hypothermia (p=0.03) and procalcitonin ≥1 μg/L (p=0.02) concurrent with blood culture sampling.

This retrospective cohort study was conducted over a 14-year period (2003–2016) to identify admission risk factors predictive of bacteraemia and the accompanying clinical or biochemical markers associated with positive blood cultures. It was limited by its use of a reference centre.

“Sepsis is the main cause of death in SJS and TEN,” according to the investigators.

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Most Read Articles
01 Dec 2019
Macrolide antibiotics are derived from the Streptomycesspecies. These contain either 14-membered (erythromycin [ERM],clarithromycin [CAM], roxithromycin [RXM]), 15-membered(azithromycin [AZM]) or 16-membered (spiramycin, josamycin,midecamycin) macrocyclic lactone rings. They inhibit proteinsynthesis by reversibly binding to the 23S ribosomal RNA (rRNA)in the 50s subunit of the bacterial ribosome. Traditionally,macrolides are used as first-line agents in respiratory, skin,soft tissue, and urogenital infections, and they are also activeagainst gram-positive cocci and atypical pathogens.
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Pneumonia is a common infection– affecting around 3,200 people inSingapore in 2016 – making it the thirdmost common cause of hospitalisation inthe country. Its common complications,especially with delayed or inappropriatetreatment, include bacteraemia andseptic shock, lung abscesses, pleuraleffusions, empyema, pleurisy, respiratoryfailure and renal failure.