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Journal Articles Critical Care Year : 2023

Skin biopsy in adult patients with meningococcal purpura fulminans: a multicenter retrospective cohort study

Damien Contou
Gaëtan Béduneau
  • Function : Author
Charlotte Rabault
  • Function : Author
Romain Sonneville
  • Function : Author
Antoine Marchalot
  • Function : Author
Rémi Coudroy
  • Function : Author
Damien Roux
  • Function : Author
Martin Cour
  • Function : Author
Julien Massol
  • Function : Author
Sébastien Préau
Nicolas de Prost
Frédéric Pène
  • Function : Author
Gwenhaël Colin
  • Function : Author
François Barbier
  • Function : Author
Kamel Toufik
  • Function : Author
Quentin Quelven
  • Function : Author
Guillaume Schnell
  • Function : Author
Stephan Ehrmann
  • Function : Author
Hélène Messet
  • Function : Author
Antoine Kimmoun
  • Function : Author
Pascal Beuret
  • Function : Author
Cédric Bruel
Delphine Colling
  • Function : Author
Alexandre Conia
  • Function : Author
Luis Ensenyat Martin
  • Function : Author
Danielle Reuter
  • Function : Author
Vincent Das
  • Function : Author
Marion Challier
  • Function : Author
Mathieu Jozwiak
  • Function : Author
Arnaud Galbois
  • Function : Author
Mégan Fraisse
  • Function : Author
Samir Jaber
  • Function : Author
Sébastien Jochmans
  • Function : Author
Pierre Kalfon
  • Function : Author
Marie Conrad
  • Function : Author
Alexandre Lautrette
Cédric Darreau
  • Function : Author
Nicolas Lerolle
  • Function : Author
Hugues Georges
  • Function : Author
Bruno Mégarbane
Claire Pichereau
  • Function : Author
Tomas Urbina
  • Function : Author
Eric Maury
  • Function : Author
Nicolas de Prost
  • Function : Author
Jean-Pierre Quenot
  • Function : Author
Bertrand Sauneuf
  • Function : Author
Matthieu Schmidt
  • Function : Author
Xavier Valette
  • Function : Author
Lara Zafrani
  • Function : Author
Daniel da Silva
  • Function : Author
Guillaume Rigault
  • Function : Author

Abstract

Abstract Background Neisseria meningitidis is the leading responsible bacterium of Purpura Fulminans (PF) accounting for two thirds of PF. Skin biopsy is a simple and minimally invasive exam allowing to perform skin culture and polymerase chain reaction (PCR) to detect Neisseria meningitidis . We aimed to assess the sensitivity of skin biopsy in adult patients with meningococcal PF. Methods A 17-year multicenter retrospective cohort study including adult patients admitted to the ICU for a meningococcal PF in whom a skin biopsy with conventional and/or meningococcal PCR was performed. Results Among 306 patients admitted for PF, 195 had a meningococcal PF (64%) with a skin biopsy being performed in 68 (35%) of them. Skin biopsy was performed in median 1 day after the initiation of antibiotic therapy. Standard culture of skin biopsy was performed in 61/68 (90%) patients and grew Neisseria meningitidis in 28 (46%) of them. Neisseria meningitidis PCR on skin biopsy was performed in 51/68 (75%) patients and was positive in 50 (98%) of them. Among these 50 positive meningococcal PCR, five were performed 3 days or more after initiation of antibiotic therapy. Finally, skin biopsy was considered as contributive in 60/68 (88%) patients. Identification of the meningococcal serogroup was obtained with skin biopsy in 48/68 (71%) patients. Conclusions Skin biopsy with conventional culture and meningococcal PCR has a global sensitivity of 88% and should be systematically considered in case of suspected meningococcal PF even after the initiation of antimicrobial treatment.

Dates and versions

hal-04297835 , version 1 (21-11-2023)

Identifiers

Cite

Damien Contou, Gaëtan Béduneau, Charlotte Rabault, Romain Sonneville, Antoine Marchalot, et al.. Skin biopsy in adult patients with meningococcal purpura fulminans: a multicenter retrospective cohort study. Critical Care, 2023, 27 (1), pp.166. ⟨10.1186/s13054-023-04461-2⟩. ⟨hal-04297835⟩
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