抗生素相关与非抗生素相关迟发性皮肤不良反应的比较分析。
A Comparative Analysis Between Antibiotic- and Nonantibiotic-Associated Delayed Cutaneous Adverse Drug Reactions.
机构信息
Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Victoria, Australia; Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia.
出版信息
J Allergy Clin Immunol Pract. 2016 Nov-Dec;4(6):1187-1193. doi: 10.1016/j.jaip.2016.04.026. Epub 2016 Jun 7.
BACKGROUND
The difference in clinical presentation, causality assessments, and outcomes of patients with delayed antibiotic-associated cutaneous adverse drug reactions (AA-cADR) and nonantibiotic-associated (NA)-cADR is ill defined.
OBJECTIVE
We examined the etiology of AA-cADR, with regard to the type of antibiotic exposure, allergy labeling, and patient outcomes, in comparison with NA-cADR.
METHODS
A retrospective observational inpatient cohort study of cADR was performed from January 2004 to August 2014. Patients were divided into AA-cADR and NA-cADR groups for analysis. cADR was defined as erythema multiforme, fixed drug eruption, acute generalized erythematous pustulosis, drug reaction with eosinophilia and systemic symptoms (DRESS), drug-associated linear IgA disease, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
RESULTS
Of the 84 patients with cADR, 48% were AA-cADR. Male sex (60% vs 32%, P = .004), median length of stay (14.5 vs 11 days, P = .05), median Charlson comorbidity index (3 vs 1, P = .03), and inpatient mortality (20% vs 5%, P = .04) were higher in AA-cADR compared with NA-cADR. The median drug latency was lower in AA-cADR (6 vs 20 days, P = .001). Sulfonamide antibiotics and glycopeptides were implicated in 20% of AA-cADR. DRESS was more frequently reported in AA-cADR. After cADR diagnosis, further antibiotic therapy was administered in 64% of patients, higher in AA-cADR (75%, 30 of 40) compared with NA-cADR (55%, 24 of 44) (P = .06). Fluoroquinolones (53% vs 21%, P = .02), glycopeptides (vancomycin and teicoplanin; 70% vs 38%, P = .05), and carbapenems (33% vs 13%, P = .11) were used more commonly in AA-cADR.
CONCLUSIONS
Antibiotics were the cause of cADR requiring hospital admission in 48% of episodes, and were associated with longer length of stay, higher age-adjusted Charlson comorbidity index, shorter drug latency, and mortality. In AA-cADR, glycopeptide and sulfonamide antibiotic exposure predominated.
背景
抗生素相关性迟发性皮肤不良反应（AA-cADR）和非抗生素相关性（NA）-cADR 患者的临床表现、因果评估和结局存在差异，但目前尚未明确。
目的
我们研究了 AA-cADR 的病因，比较了与 NA-cADR 相比，抗生素暴露类型、过敏标签和患者结局与 AA-cADR 的关系。
方法
这是一项回顾性观察性住院队列研究，纳入了 2004 年 1 月至 2014 年 8 月期间发生的 cADR 患者。患者分为 AA-cADR 和 NA-cADR 两组进行分析。cADR 定义为多形性红斑、固定性药疹、急性泛发性脓疱性银屑病、药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）、药物相关性线性 IgA 疾病、史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症。
结果
在 84 例 cADR 患者中，48%为 AA-cADR。与 NA-cADR 相比，AA-cADR 中男性（60% vs. 32%，P=0.004）、中位住院时间（14.5 天 vs. 11 天，P=0.05）、中位 Charlson 合并症指数（3 分 vs. 1 分，P=0.03）和住院死亡率（20% vs. 5%，P=0.04）更高。AA-cADR 的药物潜伏期更短（6 天 vs. 20 天，P=0.001）。磺胺类抗生素和糖肽类抗生素分别占 AA-cADR 的 20%。DRESS 在 AA-cADR 中更常见。在 cADR 诊断后，64%的患者接受了进一步的抗生素治疗，AA-cADR 组（75%，40 例）高于 NA-cADR 组（55%，24 例）（P=0.06）。氟喹诺酮类（53% vs. 21%，P=0.02）、糖肽类（万古霉素和替考拉宁；70% vs. 38%，P=0.05）和碳青霉烯类（33% vs. 13%，P=0.11）在 AA-cADR 中更常用。
结论
抗生素是导致 48%需要住院治疗的 cADR 的原因，与较长的住院时间、较高的年龄调整 Charlson 合并症指数、较短的药物潜伏期和死亡率相关。在 AA-cADR 中，糖肽类和磺胺类抗生素暴露更为常见。
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