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

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

• MeSH
• bronchoskopie * MeSH
• lidé MeSH
• respirační sliznice diagnostické zobrazování   MeSH
• Stevensův-Johnsonův syndrom diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH

V rokoch 2004−2013 bolo na našom pracovisku hospitalizovaných 2 320 pacientov s termickým poranením, z nich 87 utrpelo popáleniny elektrickým prúdom (3,75 %). Väčšinu elektricky popálených tvorili muži v počte 67 (76,74 %), potom deti v počte 18 (20,94 %) nakoniec 2 ženy (2,32 %). Mechanizmus popálenia v skupine mužov bol v 54,1 % priamy kontakt zo zdrojom prúdu, v 37,9 % popálenina elektrickým oblúkom, v 6,1 % vznietenie šatstva a následné popálenie plameňom, v 1,5 % prípadu popálenina bleskom. Mechanizmus popálenia v skupine detí bol v 83,4 % kontaktné poranenie, 16,6 % popálenie elektrickým oblúkom, v tejto skupine sa nevyskytol prípad vznietenia alebo popálenia bleskom. V skupine žien (2 prípady) u oboch došlo ku kontaktnej popálenine, nevyskytol sa úraz elektrickým oblúkom, vznietením alebo bleskom. Priemerný rozsah popáleninovej plochy v skupine mužov bol 11,7 % plochy tela, v skupine detí 5,8% plochy tela a 2 % plochy tela v skupine žien. Chirurgickú liečbu (nekrektómia, kožná transplantácia, laloková plastika, amputácia) si vyžiadalo 41 prípadov v skupine mužov, 15 prípadov v skupine detí a v oboch (2) prípadoch skupiny žien.

Background: There were totally 2320 patients during the period 2004–2013 hospitalised in our workplace with thermal injury, 87 of which were electric burns (3.75%). Results: The majority of electric burns occurred to men − 67 cases (76.74%), then to children - 18 cases (20.94%) and the rest to women – 2 cases (2.32%). The mechanism of injury to the group of men was direct contact with the source of current (54.5%), electric arc injury (37.9%), ignition of clothes and subsequently flame (6.1%), and lightning injury (1.5%). The cause of injury to the group of children was contact injury (83.4%), electric arc injury (16.6%); no ignition or lightning injury occurred. The cause of injury in the group of women (2 cases) was contact injury for both; no arc, ignition or lighting injury occurred. The average extent of burn wounds was 11.7% in the group of men, 5.83% in the group of children and 2% in the group of women. Surgical treatment (necrectomy, skin grafting, flap, and amputation) was necessary in 41 cases in the group of men, in 15 cases in the group of children and in 2 cases in the group of women. Discussion and conclusion: Electric injury is a common problem in modern world. Some authors reported a 16.9% contribution of electric injuries of all hospitalised burn patients. There were 3.75% electric injury cases of all hospitalised burn patients in our department in the last nine years. The occurrence varies from year to year.

• MeSH
• amputace statistika a číselné údaje   MeSH
• chirurgické laloky statistika a číselné údaje   MeSH
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• popálení elektrickým proudem * epidemiologie   chirurgie   MeSH
• transplantace kůže statistika a číselné údaje   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Slovenská republika MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH