Toxic epidermal necrolysis (TEN) is a rare disease, which predominantly manifests as damage to the skin and mucosa. Antibiotics count among the most common triggers of this hypersensitive reaction. Patients with TEN are highly susceptible to infectious complications due to the loss of protective barriers and immunosuppressant therapy. The aim of this study was to investigate the potential relationship between antibiotics used before the development of TEN and early and late-onset infectious complications in TEN patients. In this European multicentric retrospective study (Central European Lyell syndrome: therapeutic evaluation (CELESTE)), records showed that 18 patients with TEN used antibiotics (mostly aminopenicillins) before the disease development (group 1), while in 21 patients, TEN was triggered by another factor (group 2). The incidence of late-onset infectious complications (5 or more days after the transfer to the hospital) caused by Gram-positive bacteria (especially by Enterococcus faecalis/faecium) was significantly higher in group 1 than in group 2 (82.4% vs. 35.0%, p = 0.007/pcorr = 0.014) while no statistically significant difference was observed between groups of patients with infection caused by Gram-negative bacteria, yeasts, and filamentous fungi (p > 0.05). Patients with post-antibiotic development of TEN are critically predisposed to late-onset infectious complications caused by Gram-positive bacteria, which may result from the dissemination of these bacteria from the primary focus.
- Publikační typ
- časopisecké články MeSH
Rapid wound closure in extensively burned patients has remained one of the major unresolved issues of medicine. Integra® is the most widely established artificial skin, which is composed of a porous matrix of cross-linked bovine collagen and chondroitin 6-sulphate covered by a semi-permeable silicone layer. We present here a (immuno)histological study of a severely burned patient with a full-thickness burn treated with a tissue-engineered dermal template (Integra®) and split-thickness skin graft-based protocol. Immunohistochemical investigation of the artificial dermis revealed that immune cell infiltration reached its peak on day 10. Tissue immunophenotyping found an increase in CD3+ cells over the course of the study as well as CD4 and CD8 positivity on day 40, indicating remaining T-cell subpopulations. We observed weak/no infiltration of NK cells (CD56+). In conclusion, the use of bi-layer Integra® represents a feasible and safe procedure resulting in formation of non-irritating dermal substitutes.
- MeSH
- chondroitin sulfáty MeSH
- hojení ran MeSH
- lidé MeSH
- popálení * chirurgie MeSH
- skot MeSH
- transplantace kůže MeSH
- umělá kůže * MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- skot MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Úvod. Výsledná kvalita jizevnaté tkáně hraje důležitou roli v návratu pacientů do normálního života a společnosti. Používání umělých kožních náhrad v klinické praxi zlepšuje funkční i kosmetické výsledky nejen u popálených pacientů. Materiál a metody. Kolagen-elastinová dermální náhrada Matriderm® umožňuje okamžitou aplikaci spolu s kožním štěpem. Autoři prezentují na souboru 10 pacientů první zkušenosti s použitím dermální náhrady Matridem® v léčbě kožních ztrát různé etiologie. Výsledky. Průměrná doba hojení v soboru byla 19,6 dne, hojení probíhalo bez závažných infekčních komplikací s dobrým kosmetickým a funkčním výsledkem. Závěr. Matriderm® představuje alternativní variantu dosud nejčastěji používané dermální náhrady Integra® v léčbě akutních kožních ztrát různé etiologie i v rekonstrukční chirurgii.
Introduction. The quality of resulting scar tissue plays an important role in patients' return to normal life and full functioning in society. The use of artificial skin substitutes in clinical practice improves functional and cosmetic outcomes. This is true for any patient, and not only those suffering from burns. Material and methods. The collagen elastin dermal substitute Matriderm® allows for immediate application of a dermal substitute together with a skin graft. The authors present a group of 10 patients representing their first experience in utilizing Matriderm® as a dermal substitute in the treatment of skin losses due to various etiologies. Results. The average healing time in the group was 19.6 days. Healing took place without serious infectious complications and with good functional results. Conclusion. Matriderm® can be utilized as an alternative to the most commonly used dermal substitute so far, Integra® , in the treatment of acute skin loss due to various etiologies and in reconstructive surgery.
- Klíčová slova
- Matriderm,
- MeSH
- dítě MeSH
- elastin aplikace a dávkování MeSH
- klinická studie jako téma MeSH
- kolagen aplikace a dávkování MeSH
- lidé MeSH
- transplantace kůže metody MeSH
- umělá kůže * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
The aim of the study was to identify the most important systemic and local risk factors for the development of infectious complications in patients with toxic epidermal necrolysis (TEN). MATERIAL AND METHODOLOGY: This is a multicentric study that included all patients with TEN who were hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area included a population of over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation) registry, wherein specific parameters related to epidemiological indicators and infectious complications in patients with TEN were evaluated as a retrospective analysis. RESULTS: A total of 38 patients (97%) of the group were treated with corticosteroids. The comparison of patients with different doses of corticosteroids did not exhibit a statistically significant effect of corticosteroid administration on the development of infectious complications (p=0.421). There was no effect of the extent of the exfoliated area on the development of infectious complications in this area. The average extent of the exfoliated area was 66% TBSA (total body surface area) in patients with reported infectious complications and 71% TBSA (p=0.675) in patients without infectious complications. In the case of the development of an infectious complication in the bloodstream (BSI), the increasing effect of the SCORTEN (SCORe of Toxic Epidermal Necrosis) value was monitored during hospitalization. Within 5days from the beginning of the hospitalization, the average SCORTEN value was 2.7 in 6 patients with BSI and 3.0 in 32 patients without BSI (p=0.588). In the period after the 15th day of hospitalization, 7 patients with BSI had an average SCORTEN value of 3.4, and 16 patients without BSI had an average SCORTEN value of 2.5 (p=0.079). In the case of low respiratory tract infection (LRTI), the effects of the necessity for artificial pulmonary ventilation and the presence of tracheostomy were monitored. The statistically significant effect of mechanical ventilation on the development of LRTI occurred only during the period of 11-15days from the beginning of the hospitalization (p=0.016). The effect of the tracheostomy on the development of LRTI was proven to be more significant. CONCLUSION: We did not find any statistically significant correlation between the nature of immunosuppressive therapy and the risk of developing infectious complications. We failed to identify statistically significant risk factors for the development of BSI. Mechanical ventilation and tracheostomy increase the likelihood of developing LRTIs in patients with TEN.
- MeSH
- bakteriální infekce epidemiologie MeSH
- bakteriemie epidemiologie MeSH
- cyklosporin terapeutické užití MeSH
- dospělí MeSH
- fungemie epidemiologie MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- imunologické faktory terapeutické užití MeSH
- imunosupresiva terapeutické užití MeSH
- infekce močového ústrojí epidemiologie MeSH
- intravenózní imunoglobuliny terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- mykózy epidemiologie MeSH
- pneumonie epidemiologie terapie MeSH
- registrace * MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Stevensův-Johnsonův syndrom epidemiologie terapie MeSH
- stupeň závažnosti nemoci MeSH
- tracheostomie MeSH
- umělé dýchání MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
INTRODUCTION: Toxic epidermal necrolysis (TEN) is a rare, life-threatening autoimmune disease predominantly manifested in the skin and mucous membranes. Today, infectious complications have the dominant share in mortality of TEN patients. Due to the nature of the therapy and administration of immunosuppressive medications, a wide range of potentially pathogenic microorganisms, which cause infectious complications in different compartments in these patients, is not surprising. MATERIAL AND METHODOLOGY: This is a multicentric study, which included all patients with TEN hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area was over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the registry CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation), when specific parameters relating to epidemiological indicators and infectious complications in patients with TEN were evaluated in the form of a retrospective analysis. RESULTS: In total, 39 patients with TEN were included in the study (12 patients died, mortality was 31%), who were hospitalized in the monitored period. The median age of patients in the group was 63 years (the range was 4-83 years, the mean was 51 years), the median of the exfoliated area was 70% TBSA (total body surface area) (range 30-100%, mean 67%). SCORTEN was calculated for 38 patients on the day of admission. Its median in all patients was 3 (range 1-6; mean 3). Any kind of infectious complication in the study group was recorded in 33 patients in total (85%). In total, 30 patients (77%) were infected with gram-positive cocci, 27 patients (69%) with gram-negative rods, and yeast cells or fibrous sponge were cultivated in 12 patients (31%). A total of 32 patients (82%) were found to have infectious complications in the exfoliated area, 15 patients (39%) had lower respiratory tract infections, 18 patients (46%) urinary tract infections and 15 patients (39%) an infection in the bloodstream. The most common potentially pathogenic microorganism isolated in our study group was coagulase neg. Staphylococcus, which caused infectious complications in 24 patients. Enterococcus faecalis/faecium (19 patients), Pseudomonas aeruginosa (17 patients), Staphylococcus aureus (11 patients) and Escherichia coli (11 patients) were other most frequently isolated micro-organisms. CONCLUSION: The published data were obtained from the unique registry of TEN patients in Central Europe. In the first part, we have succeeded in defining the basic epidemiological indicators in the group of patients anonymously included in this registry. The study clearly confirms that infectious complications currently play an essential role in TEN patients, often limiting the chances of survival. The study also shows a high prevalence of these complications in the period after 15days from the start of hospitalization, when most patients already have completely regenerated skin cover.
- MeSH
- aspergilóza epidemiologie mortalita MeSH
- bakteriální infekce epidemiologie mikrobiologie mortalita MeSH
- bakteriemie epidemiologie mikrobiologie mortalita MeSH
- dítě MeSH
- dospělí MeSH
- Enterococcus faecalis MeSH
- Enterococcus faecium MeSH
- infekce močového ústrojí epidemiologie mikrobiologie mortalita MeSH
- infekce vyvolané Escherichia coli epidemiologie mortalita MeSH
- kandidóza epidemiologie mortalita MeSH
- katétrové infekce epidemiologie mikrobiologie mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mykózy epidemiologie mikrobiologie mortalita MeSH
- pneumonie epidemiologie mikrobiologie mortalita MeSH
- povrch těla MeSH
- předškolní dítě MeSH
- prevalence MeSH
- proporcionální rizikové modely MeSH
- pseudomonádové infekce epidemiologie mikrobiologie mortalita MeSH
- Pseudomonas aeruginosa MeSH
- registrace * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stafylokokové infekce epidemiologie mikrobiologie mortalita MeSH
- Staphylococcus aureus MeSH
- Stevensův-Johnsonův syndrom epidemiologie mikrobiologie mortalita MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
Východiska: Dermální náhrada Integra? má široké spektrum využití jak v popáleninové medicíně, tak v rekonstrukční, plastické chirurgii a traumatologii. Od roku 2002 je součástí chirurgické léčby pacientů na Klinice popáleninové medicíny Fakultní nemocnice Královské Vinohrady. Soubor: Integra? byla v období 2002–2016 použita celkem u 47 pacientů. Z toho 28 pacientů byly děti, 19 pacientů bylo starších 18 let. Jedenáct dětí bylo operováno v rekonstrukčním období, 8 dětí v rámci akutního úrazu. U 11 dospělých byla Integra? aplikována v rámci traumatu, u 9 při rekonstrukci. V roce 2016 bylo vyšetřeno celkem 11 pacientů léčených Integrou? v odstupu nejméně 2 roky od aplikace. Průměrná doba od aplikace byla 9 let. U všech kontrolovaných pacientů byla Integra? primárně použita při řešení akutního úrazu. Metodika: U jednotlivých pacientů byly porovnávány jizvy po aplikaci Integry? s jizvou řešenou dermoepidermálním štěpem (DE). Vyhodnocení proběhlo na základě subjektivního a objektivního vyšetření pomocí modifikované Vancouverské škály (VSS). Byly odebrány vzorky na histologické a imunohistochemické vyšetření. Výsledky: Podle VSS dosahovala místa s Integrou? průměrně 1,4 bodu. Jizvy po dermoepidermální transplantaci vykazovaly 4 body škály. Subjektivně pacienti funkční a kosmetickou kvalitu jizev ve všech případech uvedli jako lepší v porovnání s DE transplantací. Histologickým vyšetřením byly zjištěny rozdíly mezi jizvami po aplikaci Integry? a DE štěpu, a to zejména v uspořádání a kvalitě kolagenních a elastických vláken a v revaskularizaci tkáně. Závěr: Arteficiální kožní náhrada Integra? je nedílnou součástí chirurgické strategie řešení rozsáhlých popáleninových traumat a má významné využití v rekonstrukční chirurgii. Výsledná kvalita jizvy se zdá být při použití Integry? objektivně i subjektivně lepší než u DE transplantace.
Introduction: Integra? dermal replacement has a wide spectrum of use both in burn medicine as well as in reconstructive plastic surgery and traumatology. Since 2002, it has been a part of surgical treatment of patients at Prague Burns Centre of the Královské Vinohrady Teaching Hospital. Study group: Integra? was used in 47 patients in total between years 2002 and 2016. In this group there were 28 paediatric patients and 19 adult patients. Eleven children were operated during the reconstructive period, 8 children had an acute injury. There were 11 adult patients with Integra? applied within the trauma treatment, another 9 during reconstructive surgery. In 2016, we examined 11 patients treated by Integra?, at least 2 years ago. The average time since the application was 9 years. All examined patients had Integra? primarily applied to treat an acute injury. Method: Scars after the application of Integra? were compared with scars after dermoepidermal grafts (DE) in respective patients. Evaluation was performed on the basis of subjective and objective assessment by means of the modified Vancouver Scale (VSS). Samples were submitted for a histological and immunohistochemical analysis. Results: Areas with Integra? coverage scored 1.4 points on average on the VSS. The scars after dermoepidermal graft scored 4 points on the same scale. Subjective assessment of functional and cosmetic quality of scars by patients was better in all cases in comparison to DE grafting. Notable differences were found between scars following Integra? application and those after DE grafting on histological assessment, namely in the organization and quality of collagen and elastin fibres as well as in tissue revascularization. Conclusion: The Integra? artificial skin replacement is a part of surgical strategy in management of extensive burn trauma and plays an important role in reconstructive surgery. The resulting scar quality when using Integra? seems to be better than in DE grafting both from an objective and subjective points of view..
- Klíčová slova
- Integra, dermoepiderální štěp,
- MeSH
- chemické popálení terapie MeSH
- chondroitin sulfáty terapeutické užití MeSH
- dítě MeSH
- dospělí MeSH
- hojení ran MeSH
- kolagen terapeutické užití MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- následné studie MeSH
- orgány z umělého a biologického materiálu MeSH
- popálení elektrickým proudem terapie MeSH
- popálení * terapie MeSH
- transplantace kůže MeSH
- umělá kůže * využití MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Klíčová slova
- hydrochirurgie, enzymatická nekrektomie,
- MeSH
- debridement * metody přístrojové vybavení MeSH
- diagnostické techniky a postupy MeSH
- diagnostické vybavení MeSH
- enzymoterapie MeSH
- enzymy MeSH
- hydroterapie metody přístrojové vybavení MeSH
- lasery využití MeSH
- lidé MeSH
- popálení * diagnóza terapie MeSH
- rány a poranění terapie MeSH
- stříbro farmakologie terapeutické užití MeSH
- umělá kůže využití MeSH
- Check Tag
- lidé MeSH