title: 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.
authors.affiliation: From the *Victorian Adult Burns Service, †Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia; ‡Department of Surgery, School of Medicine, Faculty of Health, Deakin University, Victoria, Australia; §School of Public Health & Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia; ║Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia; and Departments of ¶Medicine and #Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Mahar
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
authors.forename: Heather
authors.initials: H
authors.lastname: Cleland
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.forename: Douglas
authors.initials: D
authors.lastname: Gin
authors.forename: David A
authors.initials: DA
authors.lastname: Watters
authors.forename: Philip
authors.initials: P
authors.lastname: Marsh
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Padiglione
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D002056:Burns / Q000150:complications*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents