Impact of Antibiotics Associated with the Development of Toxic Epidermal Necrolysis on Early and Late-Onset Infectious Complications

Abstract

Toxic epidermal necrolysis (TEN) is a rare disease, which predominantly manifests as damage to the skin and mucosa. Antibiotics count among the most common triggers of this hypersensitive reaction. Patients with TEN are highly susceptible to infectious complications due to the loss of protective barriers and immunosuppressant therapy. The aim of this study was to investigate the potential relationship between antibiotics used before the development of TEN and early and late-onset infectious complications in TEN patients. In this European multicentric retrospective study (Central European Lyell syndrome: therapeutic evaluation (CELESTE)), records showed that 18 patients with TEN used antibiotics (mostly aminopenicillins) before the disease development (group 1), while in 21 patients, TEN was triggered by another factor (group 2). The incidence of late-onset infectious complications (5 or more days after the transfer to the hospital) caused by Gram-positive bacteria (especially by Enterococcus faecalis/faecium) was significantly higher in group 1 than in group 2 (82.4% vs. 35.0%, p = 0.007/pcorr = 0.014) while no statistically significant difference was observed between groups of patients with infection caused by Gram-negative bacteria, yeasts, and filamentous fungi (p > 0.05). Patients with post-antibiotic development of TEN are critically predisposed to late-onset infectious complications caused by Gram-positive bacteria, which may result from the dissemination of these bacteria from the primary focus.

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Analysis of the Russian Database of Spontaneous Reports

“…The authors demonstrated that 26.9% of the cases were related to antibiotics, while other groups were less frequently reported (anticonvulsants-18.5%, analgesics/anesthetics-11.9%, and antineoplastics-11.3%) [11]. In a population of hospitalized patients with TEN (Czech Republic and Slovakia, period from 2000 to 2015) antibacterials were revealed as a cause in 46.2% (most drugs were aminopenicillins) [46]. In the study including data from 7,337,778 individuals in Hong Kong (2016 to 2021), antiinfective agents were determined as the main causative group resulting in SJS induction (43.1%), and beta-lactams were the most common drugs (20.4%) [47].…”

Toxic epidermal necrolysis in hepatitis A infection with acute-on-chronic liver failure: Case report and literature review

“…Considering that the patient's weakened immune system may cause opportunistic infections. Due to the extensive detachment of the epidermis, mucosal damage, and druginduced immunosuppression, patients with SJS/TEN are prone to infectious complications (34), and the high mortality rate of SJS/TEN is mainly due to the occurrence of sepsis (35). In addition, studies have shown that the use of corticosteroids may increase the infection rate and mortality of patients with SJS/TEN (36).…”