Secondary Bacterial Infection and Empirical Antibiotic Use in Toxic Epidermal Necrolysis Patients

Abstract

The objective of this study was to determine rates of positive bacterial cultures in patients with extensive toxic epidermal necrolysis, the rate of bacteremia, whether empirical antibiotics had been commenced, and their effectiveness when commenced. The authors conducted a retrospective chart review of patients with extensive toxic epidermal necrolysis between January 2001 and December 2012 admitted to the Victorian Adult Burns Service, Melbourne, Australia, with respect to the amount of positive cultures, number and type of organisms identified, whether empirical antibiotics had been commenced, and whether antibiotics were effective against organisms cultured. A total of 27 patients were admitted over the study period of 11 years. Seventeen of these patients developed at least one positive bacterial culture. Patients who grew positive cultures had a longer length of stay in intensive care unit and in hospital overall compared with patients who did not grow positive cultures. Thirty-five positive cultures were collected overall, with empirical antibiotics commenced in 22 cases. In terms of sensitivity, antibiotics were appropriate in 19 cases. Four patients developed bacteremia, two of whom died. This study does not dispute the generally accepted practice of avoiding prophylactic antibiotics in toxic epidermal necrolysis patients, but in the context of a relatively low rate of bacteremia in this patient population, advises appropriate and targeted empirical antibiotic use where clinical infection is suspected.

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

“…113 Antibiotic-therapy should be tailored to culture data 12,113,114 and local antibiogram. 115 Data suggest Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae organisms are the most common causes of blood stream infection in SJS/TEN. 106 Patients with SJS/TEN may develop neutropenia, especially in severe cases.…”

Secondary Bacterial Infections in Patients With Viral Pneumonia

“…Antiviral treatments deployed initially do not treat secondary bacterial infections (15). The preferred treatment for bacterial infections is generally broad-spectrum antibiotics, but this can result in undesirable side effects that have a negative impact on the normal microflora of the host (16)(17)(18). Susceptible individuals within a population can be protected from risk of some common bacterial pathogens that are also capable to cause secondary infections, for example pneumonia, if vaccines are available; furthermore, the immune system is often capable of fighting bacterial infections alone, while during a virus-bacterial infection, the complex immune responses might be inapt to eliminate bacterial-induced disease complications (19).…”

Microbiological findings and antibacterial therapy in Stevens–Johnson syndrome/toxic epidermal necrolysis patients from a Swedish Burn Center

“…Secondary bacterial infection is a common cause of morbidity in TEN patients and the high rate of infection in TEN patients has been confirmed by previous studies (Table ). Rajaratnam et al found a rate of infection of 85.7% and the lowest rate reported in the last 10 years is 62.9% . Septicemia has been described as the most frequent cause of death in TEN patients and it is validated as a factor increasing mortality .…”