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. 2024 Jul 18:15:1415830.
doi: 10.3389/fimmu.2024.1415830. eCollection 2024.

Antibiotic-induced severe cutaneous adverse reactions: a single-center retrospective study over ten years

Yun Lu #  1 , Lu Zhou #  1 , Ya Zou  1 , Hua Wei  1 , Yan Zhou  1 , Xirui Guo  1 , Qinchuan Li  1 , Yongqin Ye  1 , Liwen Zhang  2
Affiliations

Antibiotic-induced severe cutaneous adverse reactions: a single-center retrospective study over ten years

Yun Lu et al. Front Immunol. .

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: AGEP; DRESS; SJS; TEN; antibiotic; retrospective study; severe cutaneous adverse reactions.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart for case selection in this study.
Figure 2
Figure 2
Type of antibiotic-induced SCARs in this study.
Figure 3
Figure 3
Culprit antibiotics of patients with SCARs. (A) Case number of SCARs triggered by different antibiotics; (B) Case number of SCARs triggered by specific drugs in different groups; (C) Incubation period of culprit antibiotics.
Figure 4
Figure 4
Therapy for treatment of SCARs. (A) Number of patients treated with corticosteroids, IVIG, and other medications in different groups; (B) Number of patients receiving supportive care, ICU care, and plasma exchange in different groups; (C) Heat map of the number of cases with different classes of causative drugs and corresponding antibiotic replacement therapy.
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