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

Min-Hye Kim, MD, PhD; Dong Yoon Kang, MD, PhD; Young-Hee Nam, MD, PhD; Da Woon Sim, MD, PhD; Sujeong Kim, MD; Jun Kyu Lee, MD, PhD; Jung-Won Park, MD, PhD; Hye-Kyung Park, MD, PhD; Jae-Woo Jung, MD, PhD; Cheol-Woo Kim, MD, PhD; Min-Suk Yang, MD, PhD; Joo-Hee Kim, MD, PhD; Young-Min Ye, MD, PhD; Young-Il Koh, MD, PhD; Hye-Ryun Kang, MD, PhD; Seoung Ju Park; Sae-Hoon Kim

World Allergy Organization Journal (Jan 2023)

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

Min-Hye Kim, MD, PhD,
Dong Yoon Kang, MD, PhD,
Young-Hee Nam, MD, PhD,
Da Woon Sim, MD, PhD,
Sujeong Kim, MD,
Jun Kyu Lee, MD, PhD,
Jung-Won Park, MD, PhD,
Hye-Kyung Park, MD, PhD,
Jae-Woo Jung, MD, PhD,
Cheol-Woo Kim, MD, PhD,
Min-Suk Yang, MD, PhD,
Joo-Hee Kim, MD, PhD,
Young-Min Ye, MD, PhD,
Young-Il Koh, MD, PhD,
Hye-Ryun Kang, MD, PhD,
Seoung Ju Park,
Sae-Hoon Kim

Affiliations

Min-Hye Kim, MD, PhD: Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
Dong Yoon Kang, MD, PhD: Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea; Department of Allergy and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea; Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea; Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea; Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea; Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea; Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea; Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Preventive Medicine, Ulsan University Hospital, Ulsan, Korea
Young-Hee Nam, MD, PhD: Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
Da Woon Sim, MD, PhD: Department of Allergy and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
Sujeong Kim, MD: Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
Jun Kyu Lee, MD, PhD: Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
Jung-Won Park, MD, PhD: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Hye-Kyung Park, MD, PhD: Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
Jae-Woo Jung, MD, PhD: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
Cheol-Woo Kim, MD, PhD: Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
Min-Suk Yang, MD, PhD: Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
Joo-Hee Kim, MD, PhD: Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
Young-Min Ye, MD, PhD: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
Young-Il Koh, MD, PhD: Department of Allergy and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
Hye-Ryun Kang, MD, PhD: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
Seoung Ju Park: Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea; Corresponding author. Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju, 54907, Korea
Sae-Hoon Kim: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Corresponding author. Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 13620, Korea

Journal volume & issue: Vol. 16, no. 1
p. 100738

Abstract

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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.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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