Acta Dermato-Venereologica 99-2CompleteContent | Page 14

170 CLINICAL REPORT Prevalence and Clinical Characteristics of Cutaneous Manifestations Associated with Bacteraemia: A Cross-sectional Prospective Study Hélène TAQUIN 1 , Thomas HUBICHE 1 , Laurent ROUDIÈRE 2 , Agnès FRIBOURG 2 and Pascal DEL GIUDICE 1 Department of Dermatology, and 2 Department of Bacteriology, Hospital of Fréjus Saint Raphaël, Fréjus, France 1 Bacteraemias are life-threatening conditions that re- quire rapid care and antibiotherapy. Dermatological signs might help in deciding the most relevant treat- ment. The aim of this study was to determine the pre- valence and clinical characteristics of cutaneous mani- festations in hospitalized patients with bacteraemia. A cross-sectional study was conducted over a period of 1 year. All consecutive patients with a bacteraemia (ex- cept contaminations) were included and examined by a dermatologist within 48 h after positive blood cultu- res. Clinical (skin manifestations, diagnosis, origin of the bacteraemia) and laboratory (bacteria) data were recorded. In total, 401 bacteraemias in 375 patients were included for the final analysis. Thirty-nine cuta- neous manifestations in 34 patients were noted, cor- responding to a prevalence of 9%; 69% (n  = 27) were considered primary cutaneous manifestations, 18% (n  = 7) as secondary ones, 10% (n  = 4) as contiguous, and 3% (n  = 1) as undetermined. Gram-positive cocci, specifically Staphylococcus aureus and Streptococ- cus species, were the most frequent bacteria (n  = 27, 69%). Key words: bacteraemia; Staphylococcus aureus; Streptococ- cus pyogenes; purpura fulminans; sepsis. Accepted Oct 16, 2018; E-published Oct 17, 2018 Acta Derm Venereol 2019; 99: 170–174. Corr: Pascal del Giudice, Infectiology-Dermatology, Hospital of Fréjus Saint Raphaël, 240 Avenue de saint Lambert, FR-83600 Fréjus, France. E-mail: [email protected] B acteraemias are defined as an invasion of the blood- stream by live bacteria. The diagnosis is based on positives blood cultures associated with clinical signs of infection. Recognized to be a major cause of morbidity and mortality globally, they remain a clinical and public health concern (1, 2). Rapid and appropriate antibio­ therapies are required and associated with better outco- mes (3). Skin lesions associated with bacteraemia have been reported in isolated case reports or short selected se- ries (4). Those reports do not provide an overview of the characteristics of skin lesions in all causes of bloodstream infections. Furthermore, the prevalence of skin lesions in patients with bacteraemia is unknown. Better knowledge of these dermatological signs in bloodstream infections could help to initiate appropriate antibiotherapy. The objective of this prospective, cross-sectional study was to assess the prevalence of cutaneous manifestations doi: 10.2340/00015555-3072 Acta Derm Venereol 2019; 99: 170–174 SIGNIFICANCE Bacteraemias are life-threatening conditions that require rapid antibiotherapy. Dermatological signs might help in deciding the most relevant treatment. The aim of this study was to determine the prevalence and clinical characteris- tics of cutaneous manifestations in hospitalized patients with bacteraemia. In this study 401 bacteraemias in 375 patients were included in the final analysis: 9% had cuta- neous manifestations; 69% were primary cutaneous mani- festations, 18% as secondary ones, and 10% contiguous. Gram-positive cocci, specifically Staphylococcus aureus and Streptococcus species, were the most frequent bacteria (69%). Thus, careful dermatological examination of septic patients provides important information to enable prescrip- tion of the most relevant probabilistic antibiotherapy. in patients with bacteraemia and to describe their clinical and microbiological characteristics. METHODS Study design and patient population This monocentric, prospective, cross-sectional study was conduc- ted in a 500-bed general hospital covering an area of approximately 180,000 inhabitants, during a period of one year from 1 December 2013 to 30 November 2014. All patients with a bacteraemia were included. All episodes of bacteraemia for each patient were analy- sed. There was no age limit for inclusion in the study. Patients were excluded because of death or discharge before the dermatological examination. Contaminated blood cultures as defined afterwards were also excluded. The clinical, microbiological and epidemio- logical data were recorded on a standardized form. The study was approved by the local research ethics committee. Definitions All definitions result from the Réseau d’Alerte, d’Investigation et de Surveillance des Infections Nosocomiales (RAISIN, no- socomial infection early warning, investigation and surveillance network) (5). In the hospital, blood cultures are performed systematically for each patient presenting at least one of the following symptoms: fever > 38.0°C, hypothermia < 36°C, hypotension or chills. A bacteraemia was defined by at least one positive blood culture. For patients presenting several bacteraemias, the different episodes were included as new episodes if the isolated microorganism was different from the previous episode or if the origin of the bacte- raemia was different. Contamination was defined as the isolation of contaminant bacteria in a single blood culture set, including the following This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.