Risk Factors of Bloodstream Infection in Erythroderma from Atopic Dermatitis, Psoriasis, and Drug Reactions: a Retrospective Observational Cohort Study

Overview

Journal PeerJ

Specialties Biology
Environmental Health
General Medicine

Date 2024 Jul 15

PMID 39006018

Authors

Qian Liufu

Lulu Niu

Shimin He

Xuejiao Zhang

Mukai Chen

Affiliations

Soon will be listed here.

Abstract

Background: Atopic dermatitis (AD), psoriasis, and drug reactions associated with erythroderma are frequently complicated by infections. However, bloodstream infection (BSI) have received less research attention.

Objectives: This study aimed to investigate the clinical characteristics and risk factors associated with BSI in patients with erythroderma.

Methods: A retrospective analysis was conducted on 141 erythroderma cases. Eleven cases were identified as having BSI. Clinical records of both BSI and non-BSI groups were reviewed and compared.

Results: BSI was diagnosed in 7.80% (11/141) of erythroderma cases, with a breakdown of 7.14% in AD, 2.00% in psoriasis, and 17.14% in drug reactions. Notably, all positive skin cultures (7/7) showed bacterial isolates concordant with blood cultures. Univariate logistic regression analysis revealed several significant associations with BSI, including temperature (≤36.0 or ≥38.5 °C; odds ratio (OR) = 28.06; < 0.001), chilling (OR = 22.10; < 0.001), kidney disease (OR = 14.64; < 0.001), etiology of drug reactions (OR = 4.18; = 0.03), albumin (ALB) (OR = 0.86; < 0.01), C-reaction protein (CRP) (OR = 1.01; = 0.02), interleukin 6 (IL-6) (OR = 1.02; = 0.02), and procalcitonin (PCT) (OR = 1.07; = 0.03). Receiver operating characteristic (ROC) curves demonstrated significant associations with ALB ( < 0.001; the area under curve (AUC) = 0.80), PCT ( = 0.009; AUC = 0.74), and CRP ( = 0.02; AUC = 0.71).

Conclusions: Increased awareness of BSI risk is essential in erythroderma management. Patients with specific risk factors, such as abnormal body temperature (≤36.0 or ≥38.5 °C), chilling sensations, kidney disease, a history of drug reactions, elevated CRP (≥32 mg/L), elevated PCT (≥1.00 ng/ml), and low albumin (≤31.0 g/L), require close monitoring for BSI development.

References

Chao W, Wang C, Hsu B, Lin C, Huang W, Chen Y . Factors associated with sepsis risk in immune-mediated inflammatory diseases receiving tumor necrosis factor inhibitors: a nationwide study. Ther Adv Musculoskelet Dis. 2020; 12:1759720X20929208. PMC: 7298427. DOI: 10.1177/1759720X20929208. View

Doerflinger M, Haeusler G, Li-Wai-Suen C, Clark J, Slavin M, Babl F . Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia. Front Immunol. 2021; 12:641879. PMC: 8173204. DOI: 10.3389/fimmu.2021.641879. View

Kern W, Rieg S . Burden of bacterial bloodstream infection-a brief update on epidemiology and significance of multidrug-resistant pathogens. Clin Microbiol Infect. 2019; 26(2):151-157. DOI: 10.1016/j.cmi.2019.10.031. View

Kleinschmidt S, Huygens F, Faoagali J, Rathnayake I, Hafner L . Staphylococcus epidermidis as a cause of bacteremia. Future Microbiol. 2015; 10(11):1859-79. DOI: 10.2217/fmb.15.98. View

Drinka P, Bonham P, Crnich C . Swab culture of purulent skin infection to detect infection or colonization with antibiotic-resistant bacteria. J Am Med Dir Assoc. 2011; 13(1):75-9. DOI: 10.1016/j.jamda.2011.04.012. View

Laupland K, Leal J . Defining microbial invasion of the bloodstream: a structured review. Infect Dis (Lond). 2020; 52(6):391-395. DOI: 10.1080/23744235.2020.1727948. View

Inamadar A, Ragunatha S . The rash that becomes an erythroderma. Clin Dermatol. 2019; 37(2):88-98. DOI: 10.1016/j.clindermatol.2018.12.002. View

Pierrakos C, Vincent J . Sepsis biomarkers: a review. Crit Care. 2010; 14(1):R15. PMC: 2875530. DOI: 10.1186/cc8872. View

Cesar A, Cruz M, Mota A, Azevedo F . Erythroderma. A clinical and etiological study of 103 patients. J Dermatol Case Rep. 2016; 10(1):1-9. PMC: 4844528. DOI: 10.3315/jdcr.2016.1222. View

10.

Schlievert P, Strandberg K, Lin Y, Peterson M, Leung D . Secreted virulence factor comparison between methicillin-resistant and methicillin-sensitive Staphylococcus aureus, and its relevance to atopic dermatitis. J Allergy Clin Immunol. 2010; 125(1):39-49. PMC: 2814367. DOI: 10.1016/j.jaci.2009.10.039. View

11.

Fabre V, Sharara S, Salinas A, Carroll K, Desai S, Cosgrove S . Does This Patient Need Blood Cultures? A Scoping Review of Indications for Blood Cultures in Adult Nonneutropenic Inpatients. Clin Infect Dis. 2020; 71(5):1339-1347. DOI: 10.1093/cid/ciaa039. View

12.

Horan T, Andrus M, Dudeck M . CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36(5):309-32. DOI: 10.1016/j.ajic.2008.03.002. View

13.

Zeeuwen P, Kleerebezem M, Timmerman H, Schalkwijk J . Microbiome and skin diseases. Curr Opin Allergy Clin Immunol. 2013; 13(5):514-20. DOI: 10.1097/ACI.0b013e328364ebeb. View

14.

Lamy B, Sundqvist M, Idelevich E . Bloodstream infections - Standard and progress in pathogen diagnostics. Clin Microbiol Infect. 2019; 26(2):142-150. DOI: 10.1016/j.cmi.2019.11.017. View

15.

Huttunen R, Syrjanen J, Vuento R, Aittoniemi J . Current concepts in the diagnosis of blood stream infections. Are novel molecular methods useful in clinical practice?. Int J Infect Dis. 2013; 17(11):e934-8. DOI: 10.1016/j.ijid.2013.04.018. View

16.

Opota O, Croxatto A, Prodhom G, Greub G . Blood culture-based diagnosis of bacteraemia: state of the art. Clin Microbiol Infect. 2015; 21(4):313-22. DOI: 10.1016/j.cmi.2015.01.003. View

17.

Lecadet A, Woerther P, Hua C, Colin A, Gomart C, Decousser J . 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. J Am Acad Dermatol. 2019; 81(2):342-347. DOI: 10.1016/j.jaad.2019.03.030. View

18.

Khatib R, Riederer K, Saeed S, Johnson L, Fakih M, Sharma M . Time to positivity in Staphylococcus aureus bacteremia: possible correlation with the source and outcome of infection. Clin Infect Dis. 2005; 41(5):594-8. DOI: 10.1086/432472. View

19.

Pulido-Perez A, Bergon-Sendin M, Suarez-Fernandez R, Munoz-Martin P, Bouza E . Skin and sepsis: contribution of dermatology to a rapid diagnosis. Infection. 2021; 49(4):617-629. DOI: 10.1007/s15010-021-01608-7. View

20.

Totte J, van der Feltz W, Hennekam M, van Belkum A, van Zuuren E, Pasmans S . Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol. 2016; 175(4):687-95. DOI: 10.1111/bjd.14566. View