Incidence of bloodstream infections and predictive value of qualitative and quantitative skin cultures of patients with overlap syndrome or toxic epidermal necrolysis: A retrospective observational cohort study of 98 cases

Lecadet, Aude; Woerther, Paul‐Louis; Hua, Camille; Colin, A.; Gomart, Camille; Decousser, Jean‐Winoc; Dessap, Armand Mekontso; Wolkenstein, Pierre; Chosidow, Olivier; Prost, Nicolas de; Ingen‐Housz‐Oro, Saskia

doi:10.1016/j.jaad.2019.03.030

Cited by 14 publications

(14 citation statements)

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“…It should be noted that the main cause of mortality in patients with TEN is multiorgan failure due to sepsis. 56 In this scenario, acute renal failure is critical for prognosis. 57 In fact, a new prognostic scale for SJS/ TEN, referred as ABCD-10, has been recently developed.…”

Section: Discussionmentioning

confidence: 99%

“…found a significantly higher mortality rate in patients undergoing haemodialysis, as a result of the worsening of chronic renal failure or the development of acute renal failure. It should be noted that the main cause of mortality in patients with TEN is multiorgan failure due to sepsis . In this scenario, acute renal failure is critical for prognosis .…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of SCORTEN to predict the prognosis of Stevens‐Johnson syndrome/toxic epidermal necrolysis: a systematic review and meta‐analysis

Torres‐Navarro

Briz‐Redón

Botella‐Estrada

2020

Acad Dermatol Venereol

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Background The SCORTEN score is a specific predictor of the probability of death for patients diagnosed with Stevens‐Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Objectives To evaluate the overall accuracy of SCORTEN and the influence of several moderators such as age, sex, geographical region and age of the study. Methods A systematic search was performed on MEDLINE, The Cochrane Library, EMBASE, SCOPUS and Web of Knowledge, with no restriction on language (last update 5 February 2019 for all databases). Original studies on the use of SCORTEN were eligible. The standardized mortality ratio (SMR), defined as the quotient between the number of deaths observed and the number expected following SCORTEN, was taken as the measurement of analysis. Results Sixty‐four papers were part of the main meta‐analysis carried out in the study. A pooled log(SMR) of −0.0889 (95% CI: −0.2023 to 0.0245) was obtained, suggesting a reasonable behaviour of SCORTEN as a predictor of mortality. The possible influence of several factors in the accuracy of SCORTEN was studied by means of meta‐regression models. Multivariate meta‐regression allowed finding that the mean age of the patients and the ending year of the study are the only factors that significantly influence SCORTEN predictions. The mean age of the group of patients was associated with a significant increase in the observed/expected ratio, whereas a progressive reduction in the observed/expected ratio can be appreciated over the years. Finally, an underestimation of mortality was found for SCORTEN values of 3 or less and the opposite for those above 3 (SCORTEN range: 0–7). Conclusions The rarity of the disease and the heterogeneity of the studies included are major limitations. Despite the overall remarkable accuracy displayed by SCORTEN, the influence of several factors, as comorbidities (e.g. renal impairment), involved body surface area and patient's age, seem of enough relevance to consider a redefinition of the scale.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Accuracy of SCORTEN to predict the prognosis of Stevens‐Johnson syndrome/toxic epidermal necrolysis: a systematic review and meta‐analysis

Torres‐Navarro

Briz‐Redón

Botella‐Estrada

2020

Acad Dermatol Venereol

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“…[16][17][18] The two most frequent complications of SJS and TEN are (i) sepsis, 19 as injured skin can serve as a portal of entry, together with venous, arterial or bladder catheters, and (ii) respiratory failure, with the need for mechanical ventilation. [20][21][22][23] The management of patients with SJS/TEN in a referral centre has been shown to improve patient prognosis. [24][25][26][27] To date, there are no standardized recommendations or treatment guidelines for adjuvant treatment in SJS/TEN.…”

mentioning

confidence: 99%

Supportive care in the acute phase of Stevens–Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi‐based consensus

Brüggen

Walsh³

et al. 2021

Br J Dermatol

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Background Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking. Objectives Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN. Methods Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method. Results Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements. Conclusions We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.What is already known about this topic?• Supportive care is the cornerstone of management of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in the acute phase.• There is no consensus or guideline on the best supportive care.

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“…3 In our centre, Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA) are the most frequently involved pathogens, as previously demonstrated. 4 Here, we assessed the composition of the skin microbiota by 16S metagenomics (V3-V4 primers) 5 to provide additional information regarding the dynamics of microbiota during the acute phase of TEN. The median age of the patients was 41 (range 35-55) years old and were a majority of female patients (n = 4).…”

mentioning

confidence: 99%

“…Apremilast is an oral phosphodiesterase-4 (PDE-4) inhibitor which shares a phthalimide ring structure with thalidomide and targets the same inflammatory molecules which have a role in ENL. Based on recent case reports of its successful use in chronic recalcitrant ENL, 3,4 we conducted a prospective, single-group, pilot study after obtaining prior approval from the institutional research and ethics committee.…”

mentioning

confidence: 99%

16S metagenomic assessment of the skin microbiota dynamic and possible association with the risk of infection in patients with epidermal necrolysis

Lavaud

Hüssler

Gricourt

et al. 2021

Acad Dermatol Venereol

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Incidence of bloodstream infections and predictive value of qualitative and quantitative skin cultures of patients with overlap syndrome or toxic epidermal necrolysis: A retrospective observational cohort study of 98 cases

Cited by 14 publications

References 14 publications

Accuracy of SCORTEN to predict the prognosis of Stevens‐Johnson syndrome/toxic epidermal necrolysis: a systematic review and meta‐analysis

Accuracy of SCORTEN to predict the prognosis of Stevens‐Johnson syndrome/toxic epidermal necrolysis: a systematic review and meta‐analysis

Supportive care in the acute phase of Stevens–Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi‐based consensus

16S metagenomic assessment of the skin microbiota dynamic and possible association with the risk of infection in patients with epidermal necrolysis

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