Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, Md; Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University, Baltimore, Md.
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2021 Feb;9(2):906-912. doi: 10.1016/j.jaip.2020.09.027. Epub 2020 Oct 1.
Vancomycin, the most common antimicrobial used in US hospitals, can cause diverse adverse reactions, including hypersensitivity reactions (HSRs). Yet, little is known about vancomycin reactions documented in electronic health records.
To describe vancomycin HSR epidemiology from electronic health record allergy data.
This was a cross-sectional study of patients with 1 or more encounter from 2017 to 2019 and an electronic health record vancomycin drug allergy label (DAL) in 2 US health care systems. We determined prevalence and trends of vancomycin DALs and assessed active DALs by HSR phenotype determined from structured (coded) and unstructured (free-text) data using natural language processing. We investigated demographic associations with documentation of vancomycin red man syndrome (RMS).
Among 4,490,618 patients, 14,426 (0.3%) had a vancomycin DAL with 18,761 documented reactions (2,248 [12.0%] free-text). Quarterly mean vancomycin DALs added were 253 ± 12 and deleted were 12 ± 2. Of 18,761 vancomycin HSRs, 7,903 (42.1%) were immediate phenotypes and 3,881 (20.7%) were delayed phenotypes. Common HSRs were rash (32% of HSRs) and RMS (16% of HSRs). Anaphylaxis was coded in 6% cases of HSRs. Drug reaction eosinophilia and systemic symptoms syndrome was the most common coded vancomycin severe cutaneous adverse reaction. RMS documentation was more likely for males (odds ratio, 1.30; 95% CI, 1.17-1.44) and less likely for blacks (odds ratio, 0.59; 95% CI, 0.47-0.75).
Vancomycin causes diverse adverse reactions, including common (eg, RMS) and severe (eg, drug reaction eosinophilia and systemic symptoms syndrome) reactions entered as DAL free-text. Anaphylaxis comprised 6% of documented vancomycin HSRs, although true vancomycin IgE-mediated reactions are exceedingly rare. Improving vancomycin DAL documentation requires more coded entry options, including a coded entry for RMS.
万古霉素是美国医院最常用的抗菌药物，可引起多种不良反应，包括过敏反应（HSR）。然而，电子健康记录中记录的万古霉素反应知之甚少。
从电子健康记录过敏数据描述万古霉素 HSR 流行病学。
这是一项在美国 2 个医疗保健系统中，对 2017 年至 2019 年有 1 次或多次就诊且有电子健康记录万古霉素药物过敏标签（DAL）的患者进行的横断面研究。我们确定了万古霉素 DAL 的患病率和趋势，并使用自然语言处理从结构化（编码）和非结构化（自由文本）数据评估了与 HSR 表型相关的活动 DAL。我们调查了与万古霉素红人综合征（RMS）记录相关的人口统计学关联。
在 4490618 名患者中，有 14426 名（0.3%）有万古霉素 DAL，有 18761 例记录的反应（2248 例[12.0%]为自由文本）。每季度平均添加的万古霉素 DAL 为 253±12，删除的为 12±2。在 18761 例万古霉素 HSR 中，7903 例（42.1%）为即刻表型，3881 例（20.7%）为迟发表型。常见的 HSR 是皮疹（32%的 HSR）和 RMS（16%的 HSR）。过敏反应编码在 HSR 中占 6%。药物反应嗜酸性粒细胞增多和全身症状综合征是最常见的万古霉素严重皮肤不良反应编码。RMS 的记录更可能发生在男性（比值比，1.30；95%置信区间，1.17-1.44），而不太可能发生在黑人（比值比，0.59；95%置信区间，0.47-0.75）。
万古霉素可引起多种不良反应，包括常见（如 RMS）和严重（如药物反应嗜酸性粒细胞增多和全身症状综合征）的反应，这些反应以 DAL 自由文本的形式记录。过敏反应占记录的万古霉素 HSR 的 6%，尽管万古霉素 IgE 介导的反应极为罕见。要提高万古霉素 DAL 的记录质量，需要增加更多的编码选项，包括 RMS 的编码条目。
