205 Diagnosis of Sepsis in Steven’s-Johnson Syndrome and Toxic Epidermal Necrolysis

Standard criteria used to diagnose sepsis in patients with burns does not necessarily apply to the SJS/TEN population in clinical settings. Therefore, the goal of this study was to review all SJS/TEN admissions to a provincial burn centre and assess the number of patients that had a diagnosis of sepsis using the Sepsis-3 guidelines. We included all patients admitted with a confirmed diagnosis of SJS/TEN to our burn centre from 2006–2018. Outcomes included a confirmed diagnosis of sepsis as defined by the sepsis-3 criteria, time to antibiotics, complications during hospital stay, length of stay, and mortality. A total of 42 patients were included. Mean age was 53 ± 20 years, 15 (36%) were male, and patients presented within median 8 (4–14) days of initial presentation of symptoms. The average SCORe of Toxic Epidermal Necrosis (SCORTEN) Scale on admission was 4.4 ± 1.6. Fifteen (36%) of patients had clinical documentation of sepsis. Of those with clinically documented sepsis, 80% had a positive blood culture. In the non-septic 27 patients, 33% had a positive blood culture. Nine patients (20%) died in hospital. Clinical diagnosis of sepsis in the SJS/TEN population is complicated by similarities in the clinical manifestation of infection. Use of definitions like the sepsis-3 criteria could facilitate consistency amongst clinicians and centres. The onset of sepsis and time to treatment may be impacted by increased awareness of the early signs and symptoms of SJS/TEN itself and transfer to a specialized referral centre.