Skin involvement: a harbinger of worse prognosis in patients with sepsis

Abstract Skin involvement can occur at the beginning of a septic episode (primary skin and soft tissue infections) or during its progression (secondary or metastatic skin lesions), making skin a useful accessible tissue in the study of septic patients. The objective of this study was to determine the overall prevalence of sepsis-related skin findings and evaluate their possible prognostic value. A retrospective, single-center, study of septic patients with documented bloodstream infections admitted in a tertiary hospital during 2019 was carried out. Unselected samples of 320 episodes of sepsis from 265 patients were included. Skin lesions were documented in 83 septic episodes from 69 patients (25.9%). Skin involvement was more frequently associated with bloodstream infections caused by Staphylococcus aureus (p = 0.0001), coagulase-negative staphylococci (p = 0.036), and Pseudomonas aeruginosa (p = 0.005). Mean hospital stay (37.58 days vs 27.82 days, p = 0.023) and sepsis-related mortality (18.1% vs 11.0%, p = 0.024) were higher in patients with skin lesions than in individuals without them. Our results suggest that skin involvement (primary and/or secondary) is an unfavorable indicator in the evolution of septic patients with bloodstream infections. Thorough examination of the skin is recommended in the routine evaluation of septic patients, whether or not the origin of the infection is known.