Department of Pharmacy, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
Department of Dermatovenereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
Front Immunol. 2024 Jul 18;15:1415830. doi: 10.3389/fimmu.2024.1415830. eCollection 2024.
Severe cutaneous adverse reactions (SCARs) are rare but life-threatening, with antibiotics being the main cause. This retrospective study from a single center was designed to analyze the culprit drugs, clinical features and treatment outcomes of antibiotic-induced SCARs.
We analyzed cases of antibiotic-induced SCARs in a tertiary hospital in China between January 2013 and January 2024, including Steven-Johnson syndrome (SJS) or Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap, toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Descriptive analysis of the demographic characteristics, clinical manifestations, treatment and prognosis were carried out.
Among 354 cases of SCARs, 63 validated antibiotic-related cases were included. Cephalosporins (31.7%), penicillins (25.4%), and quinolones (19.0%) were the most common triggers for SCARs. Overall, liver (50.8%), lungs (31.7%), and kidneys (23.8%) were the most frequently affected organ in SCARs cases. Eight patients (28.6%) in the SJS/SJS-TEN overlap group and 8 patients (80.0%) in the TEN group received combination therapy of corticosteroids and IVIG. Patients with SCARs caused by penicillins or cephalosporins could receive alternative treatments such as lincomamides, quinolones, and tetracyclines. The mortality rate in the TEN group was the highest at 20.0%, followed by the SJS/SJS-TEN overlap group (7.1%), and no deaths were observed in the DRESS and AGEP groups.
The identification of the culprit antibiotics and the application of alternative antibiotic therapies are crucial for the management of antibiotic-induced SCARs. If complicated underlying conditions and complications like advanced age, cancer and pneumonia coexist with SCARs, patients might be more at risk for mortality.
严重皮肤不良反应（SCARs）罕见但危及生命，抗生素是主要原因。本研究为单中心回顾性研究，旨在分析抗生素诱导的 SCARs 的致病药物、临床特征和治疗结果。
分析 2013 年 1 月至 2024 年 1 月期间中国一家三级医院的抗生素诱导的 SCARs 病例，包括史蒂文斯-约翰逊综合征（SJS）或 SJS-中毒性表皮坏死松解症（SJS-TEN）重叠、中毒性表皮坏死松解症（TEN）、药物反应伴嗜酸性粒细胞增多和全身性症状（DRESS）和急性全身性发疹性脓疱病（AGEP）。对人口统计学特征、临床表现、治疗和预后进行描述性分析。
在 354 例 SCARs 中，有 63 例验证为抗生素相关。头孢菌素（31.7%）、青霉素（25.4%）和喹诺酮类（19.0%）是 SCARs 最常见的诱因。总体而言，肝脏（50.8%）、肺部（31.7%）和肾脏（23.8%）是 SCARs 病例中最常受影响的器官。SJS/SJS-TEN 重叠组 8 例（28.6%）和 TEN 组 8 例（80.0%）接受皮质类固醇和 IVIG 的联合治疗。青霉素或头孢菌素引起的 SCARs 患者可接受林可酰胺类、喹诺酮类和四环素类等替代治疗。TEN 组死亡率最高（20.0%），其次是 SJS/SJS-TEN 重叠组（7.1%），DRESS 和 AGEP 组无死亡。
鉴定致病抗生素和应用替代抗生素治疗对管理抗生素诱导的 SCARs 至关重要。如果 SCARs 伴有高龄、癌症和肺炎等严重基础疾病和并发症，患者的死亡率可能更高。
