The objective of this study was to determine rates of positive bacterial cultures in patients with extensive
toxic epidermal necrolysis, the rate of
bacteremia, whether empirical
antibiotics had been commenced, and their effectiveness when commenced. The authors conducted a retrospective chart review of patients with extensive
toxic epidermal necrolysis between January 2001 and December 2012 admitted to the Victorian Adult
Burns Service, Melbourne, Australia, with respect to the amount of positive cultures, number and type of organisms identified, whether empirical
antibiotics had been commenced, and whether
antibiotics were effective against organisms cultured. A total of 27 patients were admitted over the study period of 11 years. Seventeen of these patients developed at least one positive bacterial culture. Patients who grew positive cultures had a longer
length of stay in intensive care unit and in hospital overall compared with patients who did not grow positive cultures. Thirty-five positive cultures were collected overall, with empirical
antibiotics commenced in 22 cases. In terms of sensitivity,
antibiotics were appropriate in 19 cases. Four patients developed
bacteremia, two of whom died. This study does not dispute the generally accepted practice of avoiding prophylactic
antibiotics in
toxic epidermal necrolysis patients, but in the context of a relatively low rate of
bacteremia in this patient population, advises appropriate and targeted empirical
antibiotic use where clinical
infection is suspected.