Resumen

Objectives: This systematic review evaluates the diversity of pathogens linked to EG, the prevalence of concurrent septicemia, and clinical patterns across presentations. Our aim is to provide evidence supporting an updated definition that reflects EG’s broader microbiologic spectrum and variable clinical manifestations, ultimately enhancing diagnostic accuracy and management in both immunocompromised and immunocompetent patients. Introduction: Ecthyma gangrenosum is considered an emergency dermatological condition and is classically defined as a Pseudomonas aeruginosa-associated necrotic skin lesion in immunocompromised patients with septicemia. Emerging evidence suggests a broader spectrum of causative pathogens and cases without concurrent septicemia. This review aims to reassess the pathogen diversity and septicemia status in EG, advocating for a more inclusive clinical definition. Materials / method: A PRISMA-compliant systematic review was conducted, screening databases such as PubMed, EMBASE, Scopus, and Web of Science. 162 studies (311 patients) reporting EG with confirmed pathogen identification were included. Data on pathogen types, septicemia presence, immune status, lesion location, and management were extracted and analyzed. Results: Pathogen diversity was observed, with Pseudomonas aeruginosa being the most common pathogen (72.2%), followed by 27.8% implicated other pathogens (MRSA: 4.9%, fungi: 3.7%, E. coli: 4.3%). Septicemia was present in 61.7% of cases and 71.0% were immunocompromised. Recovery rates varied by pathogen type, with P. aeruginosa cases having an 81.1% recovery rate, while fungal infections had a significantly lower recovery rate (47.4%). Mortality was highest with fungal pathogens (52.6% vs. P. aeruginosa: 15.1%). Conclusion: This review highlights the diverse microbial etiology of EG and challenges the traditional view of the condition being solely linked to Pseudomonas aeruginosa bacteremia. It advocate redefining EG as a pathogen-agnostic, necrosis-driven entity to improve diagnosis and management.