Microbiological findings and antimicrobial resistance dynamics in pathogens isolated from patients with toxic...

Toxic epidermal necrolysis (TEN) is one of the most life-threatening skin exfoliative disorders. The disease is frequently misdiagnosed or diagnosed with a long delay. This, together with the unique pathology, leads to a high mortality of affected patients. The high risk of infections associated with extensive loss of skin and impaired function of the immune system is one of the most common complications in TEN patients.

All patients treated at our clinic with a diagnosis of TEN between January 1, 1996, and December 31, 2020, were included in this study. Basic epidemiological parameters, the incidence of infectious complications in individual compartments, clinical laboratory and microbiological parameters, and antimicrobial resistance of pathogens isolated during the hospital stay were collected.

In total, 498 potentially pathogenic microorganisms (PPMs) were isolated in our patient group, i.e., on average more than 35 isolated PPMs per patient. Of these, 155 pathogens fell into the gram-positive spectrum (31.1%), and 331 into the gram-negative spectrum (66.5%). The effect of corticosteroid therapy on overall survival is also an interesting indicator. In patients with multifocal infection, the maximum corticosteroid dose was 965 mg of methylprednisolone, while in patients without multifocal infection, the maximum dose was 2.333 mg methylprednisolone (p = 0.032). Last but not least, we mapped the most frequently occurring pathogens, dominated by gram-negative bacteria, in particular Klebsiella sp. and Enterobacter sp. We also described the presence of antibiotic resistance in epidemiologically important pathogens in TEN patients with infectious complications.

We successfully identified basic epidemiological parameters in a cohort of patients treated with TEN along with the most frequent representatives of infectious complications. We were able to identify risk factors for the development of infectious complications and their impact on further complications of treatment as well as patient mortality.