史蒂文斯约翰逊综合征和中毒性表皮坏死松解的菌血症:主要病原体和危险因素:一个小综述

Guerrero-Putz Md, Gomez-Flores M, Ocampo-Candiani J, Alba-Rojas E
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引用次数: 1

摘要

Stevens Johnson综合征(SJS)和中毒性表皮坏死松解症(TEN)是一种以药物为主的超敏反应,以皮肤脱离为特征。它们是皮肤病学的紧急情况,菌血症是死亡的主要原因,特别是在皮肤广泛受累的患者中。我们回顾和总结了SJS和TEN患者发生菌血症的危险因素和主要病原体的大型回顾性研究。结果显示,危险因素包括:总体表面积(TBSA)大于10%、中毒性表皮坏死松解症严重程度评分(SCORTEN)较高、高血压、既往使用阿片类药物、白细胞(WBC) > 10000/mL;c反应蛋白(CRP) > 100mg/mL;降钙素原(PCT)≥1μg/L;皮肤定植铜绿假单胞菌、金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌(MRSA)。从血液培养中最常见的分离病原体是金黄色葡萄球菌、粪肠球菌、铜绿假单胞菌、肠杆菌和鲍曼不动杆菌。识别和考虑每个SJS和TEN患者的这些变量可能导致该人群中更早的诊断,适当的管理甚至预防菌血症。
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Bacteremia in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Main Pathogens and Risk Factors: A Mini Review
Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are hypersensitivity reaction, mainly to drugs, characterized by skin detachment. They are dermatological emergencies, and bacteremia is the main cause death, especially in patients with extensive cutaneous involvement. We reviewed and summarized the large retrospective studies that focused on the risk factors and main pathogens involved in patients with SJS and TEN who developed bacteremia. Our results showed that the risk factors include a Total Body Surface Area (TBSA) higher than 10%, higher Severity-of-Illness Score For Toxic Epidermal Necrolysis (SCORTEN), hypertension, previous opiate use, White Blood Cells (WBC) > 10000/mL; C-Reactive Protein (CRP) > 100mg/mL; procalcitonin (PCT) ≥ 1μg/L; and skin colonization with P. aeruginosa, S. aureus, and methicillin-resistant S. aureus (MRSA). The most frequently isolated pathogens from blood cultures were S. aureus, E. faecalis, P. aeruginosa, Enterobacter spp, and A. baumannii. The identification and consideration of these variables on each patient with SJS and TEN could result in an earlier diagnosis, proper management and even prevention of bacteremia in this population.
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