Park Jin Hwa, Hong Susie, Jun Dae Won, Yoon Jai Hoon, Lee Kang Nyeong, Lee Hang Lak, Lee Oh Young, Yoon Byung Chul, Choi Ho Soon
Department of Internal Medicine, Seoul Asan Hospital, Seoul, South Korea.
Department of Internal Medicine, Hanyang University School of Medicine, Seoul, South Korea.
Ann Transl Med. 2021 Apr;9(8):642. doi: 10.21037/atm-20-5144.
The use of antibiotics increases recently. Accordingly, the incidence of antibiotics associated with drug induced liver injury (DILI) also increases. The purpose of this study is to evaluate the proportion and the clinical characteristics of antibiotic associated with DILI.
This study is a retrospective study of analyzed adult patients who were referred to the department of hepatology for the elevation of liver function tests and the frequency of elevated liver enzyme of patients with prescribed antibiotics during the same period at outpatient setting as a validation set.
Antibiotics associated with DILI (64.0%) are the most common reason agent among consulting to hepatology department. Rheumatoid arthritis related drugs (11.0%), health supplements (5.0%), herbal medicines (4.0%), anti-viral drugs, anti-inflammatory analgesics/acetaminophen and lipid-lowering agents (3.0%) were next common causative drug for DILI in inpatients setting (training set). The frequency of antibiotics associated with DILI was high in order of flomoxef, cetrazole, ceftriaxone, vancomycin, piperacillin/tazobactam and amoxicillin/clavulanate. In the same period, 32% of the patients who prescribed flomoxef showed elevated liver enzyme levels above the upper normal limit. The prevalence of flomoxef induced DILI (>3 folds of ALT) was 13% and liver enzyme levels were five times higher than upper normal limits in 5% of flomoxef groups. Hypertension or diabetes was the risk factor of flomoxef associated with DILI.
The Prevalence of antibiotics associated with DILI was 2-14%. Co-morbidity with diabetes and hypertension was the risk factor of flomoxef associated with DILI.
近期抗生素的使用有所增加。相应地，与药物性肝损伤（DILI）相关的抗生素发生率也在上升。本研究的目的是评估与DILI相关的抗生素的比例及临床特征。
本研究是一项回顾性研究，分析在门诊环境中因肝功能检查异常而转诊至肝病科的成年患者，以及同期开具抗生素的患者肝酶升高的频率作为验证集。
与DILI相关的抗生素（64.0%）是肝病科会诊中最常见的病因。类风湿关节炎相关药物（11.0%）、保健品（5.0%）、草药（4.0%）、抗病毒药物、抗炎镇痛药/对乙酰氨基酚和降脂药（3.0%）是住院患者中DILI的第二常见致病药物（训练集）。与DILI相关的抗生素频率从高到低依次为氟氧头孢、头孢替唑、头孢曲松、万古霉素、哌拉西林/他唑巴坦和阿莫西林/克拉维酸。同期，使用氟氧头孢的患者中有32%的肝酶水平高于正常上限。氟氧头孢诱导的DILI（ALT升高>3倍）患病率为13%，在5%的氟氧头孢组中肝酶水平比正常上限高五倍。高血压或糖尿病是与氟氧头孢相关的DILI的危险因素。
与DILI相关的抗生素患病率为2 - 14%。糖尿病和高血压合并症是与氟氧头孢相关的DILI的危险因素。
