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. 2023 Jun 1;42(6):510-514.
doi: 10.1097/INF.0000000000003871. Epub 2023 Feb 14.

Bloodstream Infection in Children With Epidermolysis Bullosa

Laura García-Espinosa  1 , Teresa Del Rosal  2   3   4   5 , Lucía Quintana  6 , Rocío Maseda  6 , Carlos Grasa  2   3   4   7 , Iker Falces-Romero  7   8 , Juan José Menéndez-Suso  9 , Isabel Pérez-Conde  5 , Ana Méndez-Echevarría  2   3   4   7 , Francisco Javier Aracil Santos  2 , Luis Alfonso Alonso  2 , Raúl de Lucas  6 , Cristina Calvo  2   3   4   7 , Fernando Baquero-Artigao  2   3   4   7
Affiliations

Bloodstream Infection in Children With Epidermolysis Bullosa

Laura García-Espinosa et al. Pediatr Infect Dis J. .

Abstract

Background: Epidermolysis bullosa (EB) is frequently complicated by skin infection, which can lead to bacteremia. However, bloodstream infections (BSI) in patients with EB have not been well described.

Methods: Retrospective study of BSI in children 0-18 years with EB from a national reference unit in Spain, in 2015-2020.

Results: Among 126 children with EB, we identified 37 BSI episodes in 15 patients (14 recessive dystrophic EB, 1 junctional EB). The most frequent microorganisms were Pseudomonas aeruginosa (n = 12) and Staphylococcus aureus (n = 11). Five P. aeruginosa isolates were ceftazidime-resistant (42%), 4 of which were also resistant to meropenem and quinolones (33%). As for S. aureus , 4 (36%) were methicillin-resistant and 3 (27%) clindamycin-resistant. In 25 (68%) BSI episodes skin cultures had been performed in the previous 2 months. The most frequent isolates were also P. aeruginosa (n = 15) and S. aureus (n = 11). In 13 cases (52%), smear and blood cultures grew the same microorganism, with the same antimicrobial resistance pattern in 9 isolates. Twelve patients (10%) died during follow-up (9 RDEB and 3 JEB). BSI was the cause of death in 1 case. In patients with severe RDEB, a history of BSI was associated with higher mortality (OR 6.1, 95% CI: 1.33-27.83, P = 0.0197).

Conclusions: BSI is an important cause of morbidity in children with severe forms of EB. The most frequent microorganisms are P. aeruginosa and S. aureus , with high rates of antimicrobial resistance. Skin cultures can help guide treatment decisions in patients with EB and sepsis.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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