Bacteremia in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Main Pathogens and Risk Factors: A Mini Review

Abstract

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.