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5.
JAAD Case Rep ; 6(6): 524-527, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32490116
7.
J Am Acad Dermatol ; 81(3): 686-693, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31195022

RESUMEN

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 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. LIMITATIONS: This is a retrospective study performed in a reference center. CONCLUSION: 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.


Asunto(s)
Bacteriemia/diagnóstico , Bacterias/aislamiento & purificación , Hipotermia/diagnóstico , Índice de Severidad de la Enfermedad , Síndrome de Stevens-Johnson/complicaciones , Adulto , Anciano , Bacteriemia/sangre , Bacteriemia/etiología , Cultivo de Sangre , Superficie Corporal , Femenino , Hemoglobinas/análisis , Humanos , Hipotermia/sangre , Hipotermia/etiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Singapur , Síndrome de Stevens-Johnson/sangre , Síndrome de Stevens-Johnson/diagnóstico
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