Blood stream infections in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Risk factors and association with poor outcome

Background & Objective: Blood Stream Infections (BSI) are considered a significant cause of morbidity and mortality in patients with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). We aimed to identify risk factors for BSI upon admission, highlight clinical and microbiological findings and ascertain the frequency of mortality in patients with BSI in SJS/TEN. Methods: A retrospective cross-sectional study over 12 years (2011-2022) was performed in the department of medicine at a tertiary care hospital in Pakistan. All patients admitted with the diagnosis of SJS or TEN were included from the health information management system. We included clinical and microbiological details, reviewed medical charts, and filled out a predesigned proforma. Results: A total of 100 patients were admitted with SJS or TEN. The majority (55%) were of age greater than 40 years and had female preponderance (57%). Sixty five patients had a prior history of using a precipitating drug. BSI was seen in 19 patients; 68.4% had a mono-microbial infection, while 31.5% had a poly-microbial infection. In total, 10 organisms were identified, Staphylococcus aureus being the most common isolate followed by Enterococcus. Twelve patients required intensive care monitoring while 33 patients had hospital stays of equal or more than seven days. The overall mortality rate was 15% while it was 60% in those with BSI. SCORTEN score of ≥4 had a significant impact on mortality (60% deaths). Conclusion: Vigilant monitoring and early detection of BSI in SJS/TEN patients, especially those presenting with high SCORTEN scores can enhance clinical outcomes.