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Clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: A study from the Korea SCAR registry

BACKGROUND: Although beta-lactams are 1 of the major causative agents of severe cutaneous adverse reactions (SCAR), their epidemiology and clinical aspects have been poorly studied. This study aimed to investigate the characteristics of SCAR caused by beta-lactams in the Korean SCAR registry. METHOD...

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Autores principales: Kim, Min-Hye, Kang, Dong Yoon, Nam, Young-Hee, Sim, Da Woon, Kim, Sujeong, Lee, Jun Kyu, Park, Jung-Won, Park, Hye-Kyung, Jung, Jae-Woo, Kim, Cheol-Woo, Yang, Min-Suk, Kim, Joo-Hee, Ye, Young-Min, Koh, Young-Il, Kang, Hye-Ryun, Park, Seoung Ju, Kim, Sae-Hoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: World Allergy Organization 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9852789/
https://www.ncbi.nlm.nih.gov/pubmed/36694620
http://dx.doi.org/10.1016/j.waojou.2022.100738
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author Kim, Min-Hye
Kang, Dong Yoon
Nam, Young-Hee
Sim, Da Woon
Kim, Sujeong
Lee, Jun Kyu
Park, Jung-Won
Park, Hye-Kyung
Jung, Jae-Woo
Kim, Cheol-Woo
Yang, Min-Suk
Kim, Joo-Hee
Ye, Young-Min
Koh, Young-Il
Kang, Hye-Ryun
Park, Seoung Ju
Kim, Sae-Hoon
author_facet Kim, Min-Hye
Kang, Dong Yoon
Nam, Young-Hee
Sim, Da Woon
Kim, Sujeong
Lee, Jun Kyu
Park, Jung-Won
Park, Hye-Kyung
Jung, Jae-Woo
Kim, Cheol-Woo
Yang, Min-Suk
Kim, Joo-Hee
Ye, Young-Min
Koh, Young-Il
Kang, Hye-Ryun
Park, Seoung Ju
Kim, Sae-Hoon
author_sort Kim, Min-Hye
collection PubMed
description BACKGROUND: Although beta-lactams are 1 of the major causative agents of severe cutaneous adverse reactions (SCAR), their epidemiology and clinical aspects have been poorly studied. This study aimed to investigate the characteristics of SCAR caused by beta-lactams in the Korean SCAR registry. METHODS: We retrospectively analyzed beta-lactam-induced SCAR cases collected from 28 tertiary university hospitals in Korea between 2010 and 2015. The SCAR phenotypes included Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap, and drug reaction with eosinophilia and systemic symptoms (DRESS). Beta-lactams were classified according to their chemical structures: penicillins, cephalosporins, and carbapenems. The causative beta-lactams, clinical and laboratory features, treatments, and outcomes were evaluated. RESULTS: Among the 275 antibiotic-induced SCAR cases, 170 patients developed SCAR induced by beta-lactams. Beta-lactam antibiotic-induced SCAR showed more frequent SJS/TEN compared to SCAR induced by non-beta-lactam antibiotics (SJS/TEN/SJS-TEN overlap/DRESS: 36.5/11.2/5.9/46.5% vs. 23.8/10.5/2.9/62.9%, P = 0.049). Cephalosporin was the most common culprit drug. Particularly, 91 and 79 patients presented with SJS/TEN and DRESS, respectively. The odds ratio (OR) for poor prognosis, such as sequelae and death, was significantly increased in subjects with SJS-TEN overlap and TEN and carbapenem as culprit drug in the multivariate analysis (OR, 35.61; P = 0.016, OR, 28.07; P = 0.006, OR 30.46; P = 0.027). CONCLUSION: Among antibiotic-induced SCAR, clinical features were different depending on whether the culprit drug was a beta-lactam antibiotic or SCAR type. The poor prognosis was related to SJS-TEN overlap, TEN type, and carbapenem as the culprit drug.
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spelling pubmed-98527892023-01-23 Clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: A study from the Korea SCAR registry Kim, Min-Hye Kang, Dong Yoon Nam, Young-Hee Sim, Da Woon Kim, Sujeong Lee, Jun Kyu Park, Jung-Won Park, Hye-Kyung Jung, Jae-Woo Kim, Cheol-Woo Yang, Min-Suk Kim, Joo-Hee Ye, Young-Min Koh, Young-Il Kang, Hye-Ryun Park, Seoung Ju Kim, Sae-Hoon World Allergy Organ J Full-Length Article BACKGROUND: Although beta-lactams are 1 of the major causative agents of severe cutaneous adverse reactions (SCAR), their epidemiology and clinical aspects have been poorly studied. This study aimed to investigate the characteristics of SCAR caused by beta-lactams in the Korean SCAR registry. METHODS: We retrospectively analyzed beta-lactam-induced SCAR cases collected from 28 tertiary university hospitals in Korea between 2010 and 2015. The SCAR phenotypes included Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap, and drug reaction with eosinophilia and systemic symptoms (DRESS). Beta-lactams were classified according to their chemical structures: penicillins, cephalosporins, and carbapenems. The causative beta-lactams, clinical and laboratory features, treatments, and outcomes were evaluated. RESULTS: Among the 275 antibiotic-induced SCAR cases, 170 patients developed SCAR induced by beta-lactams. Beta-lactam antibiotic-induced SCAR showed more frequent SJS/TEN compared to SCAR induced by non-beta-lactam antibiotics (SJS/TEN/SJS-TEN overlap/DRESS: 36.5/11.2/5.9/46.5% vs. 23.8/10.5/2.9/62.9%, P = 0.049). Cephalosporin was the most common culprit drug. Particularly, 91 and 79 patients presented with SJS/TEN and DRESS, respectively. The odds ratio (OR) for poor prognosis, such as sequelae and death, was significantly increased in subjects with SJS-TEN overlap and TEN and carbapenem as culprit drug in the multivariate analysis (OR, 35.61; P = 0.016, OR, 28.07; P = 0.006, OR 30.46; P = 0.027). CONCLUSION: Among antibiotic-induced SCAR, clinical features were different depending on whether the culprit drug was a beta-lactam antibiotic or SCAR type. The poor prognosis was related to SJS-TEN overlap, TEN type, and carbapenem as the culprit drug. World Allergy Organization 2023-01-12 /pmc/articles/PMC9852789/ /pubmed/36694620 http://dx.doi.org/10.1016/j.waojou.2022.100738 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Full-Length Article
Kim, Min-Hye
Kang, Dong Yoon
Nam, Young-Hee
Sim, Da Woon
Kim, Sujeong
Lee, Jun Kyu
Park, Jung-Won
Park, Hye-Kyung
Jung, Jae-Woo
Kim, Cheol-Woo
Yang, Min-Suk
Kim, Joo-Hee
Ye, Young-Min
Koh, Young-Il
Kang, Hye-Ryun
Park, Seoung Ju
Kim, Sae-Hoon
Clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: A study from the Korea SCAR registry
title Clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: A study from the Korea SCAR registry
title_full Clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: A study from the Korea SCAR registry
title_fullStr Clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: A study from the Korea SCAR registry
title_full_unstemmed Clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: A study from the Korea SCAR registry
title_short Clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: A study from the Korea SCAR registry
title_sort clinical aspects of severe cutaneous adverse reactions caused by beta-lactam antibiotics: a study from the korea scar registry
topic Full-Length Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9852789/
https://www.ncbi.nlm.nih.gov/pubmed/36694620
http://dx.doi.org/10.1016/j.waojou.2022.100738
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