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Článek

Toxic epidermal necrolysis data from the CELESTE multinational registry. Part II: Specific systemic and local risk factors for the development of infectious complications

Lipový, B
Autor Lipový, B Department of Burns and Reconstructive Surgery, Teaching Hospital Brno, Czech Republic Faculty of Medicine, Masaryk University Brno, Czech Republic. Electronic address: b.lipovy@seznam.cz
Holoubek, J
Autor Holoubek, J Department of Burns and Reconstructive Surgery, Teaching Hospital Brno, Czech Republic
Hanslianová, M
Autor Hanslianová, M Department of Clinical Microbiology, Teaching Hospital Brno, Czech Republic
Cvanová, M
Autor Cvanová, M Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
Klein, L
Autor Klein, L Division of Plastic Surgery and Burns Treatment, Department of Surgery, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic Department of Military Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
Grossová, Ivana
Autor Autorita Prague Burn Center, Charles University, 3rd Faculty of Medicine and Teaching Hospital Královské Vinohrady, Prague, Czech Republic
Zajíček, R
Autor Zajíček, R Prague Burn Center, Charles University, 3rd Faculty of Medicine and Teaching Hospital Královské Vinohrady, Prague, Czech Republic
Bukovčan, P
Autor Bukovčan, P Department of Burns and Reconstructive Surgery, Faculty of Medicine, Comenius University in Bratislava, Slovakia
Koller, J
Autor Koller, J Department of Burns and Reconstructive Surgery, Faculty of Medicine, Comenius University in Bratislava, Slovakia
Baran, M
Autor Baran, M Department of Burns and Reconstructive Surgery, 1st Private Hospital Košice-Šaca, Slovakia

Burns. 2018 ; 44 (6) : 1561-1572. [pub] 20180611

ISSN 1879-1409
Medvik
Zdroj

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

Článek

Toxic epidermal necrolysis data from the CELESTE multinational registry. Part I: Epidemiology and general microbiological characteristics

Burns. 2018 ; 44 (6) : 1551-1560. [pub] 20180607

ISSN 1879-1409
Medvik
Zdroj

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.

Článek

Electrical burns in our workplace [Popáleniny elektrickým prúdom na našom pracovisku]

Acta chirurgiae plasticae (English ed.). 2014 ; 56 (1-2) : 13-14.

ISSN 0001-5423
Medvik
Zdroj

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.