Management of Stevens-Johnson Syndrome

Infection Prevention and Control

The British Journal of Dermatology recommends that patients with Stevens-Johnson syndrome must be barrier-nursed in isolation in a side room to reduce nosocomial infections, which are a leading cause of death in SJS/TEN 1, 2
Extensive epidermal loss creates a massive portal for infection, and the denuded dermis becomes coated with necrotic debris, acting as a substrate for microbial colonization, initially by Staphylococcus aureus and later by Gram-negative organisms, particularly Pseudomonas aeruginosa 3
Sepsis is the most common cause of death in SJS/TEN, and cutaneous infection impairs re-epithelialization and can progress to systemic sepsis, making infection prevention paramount to reducing mortality 3
Barrier nursing significantly reduces nosocomial infection risk, and is a core component of the skin management regimen applicable to all SJS patients in all settings 1, 2, 4

The isolation environment should be a side room with controlled humidity on a pressure-relieving mattress 1, 2, 4
The ambient temperature should be raised to 25-28°C to minimize insensible fluid losses and maintain thermoregulation 1, 2, 4
Strict barrier nursing protocols should be implemented to prevent introduction of pathogens 1, 2, 4

Regular bacterial and fungal surveillance cultures should be taken from three areas of lesional skin on alternate days throughout the acute phase 1, 2, 4
Clinical monitoring for infection signs, including confusion, hypotension, reduced urine output, decreased oxygen saturation, increased skin pain, rising C-reactive protein, and neutrophilia, is essential 3
Targeted antimicrobial therapy should only be used when clinically indicated, as prophylactic antibiotics increase colonization with resistant organisms, particularly Candida albicans 1, 2, 4, 5