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Vancomycin-associated drug-induced hypersensitivity syndrome
Journal of the American Academy of Dermatology ( IF 13.8 ) Pub Date : 2019-02-06 , DOI: 10.1016/j.jaad.2019.02.002
Lauren M. Madigan , Lindy P. Fox

Background

Although hypersensitivity reactions are well characterized for certain medications, vancomycin-associated drug-induced hypersensitivity syndrome (DIHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), has yet to be defined.

Objective

To better define the clinical phenotype of vancomycin-associated DIHS.

Methods

A retrospective case series was conducted over an 8-year period at a single, academic institution. A total of 29 cases of DIHS/DRESS were identified, of which 4 were attributed to vancomycin. A literature review was performed; it identified 28 additional cases of vancomycin-induced DIHS. Vancomycin-associated acute interstitial nephritis was also reviewed to detect additional, previously uncharacterized cases of systemic hypersensitivity. The review yielded 11 additional cases.

Results

In this literature review and retrospective series, the incidence of renal dysfunction among vancomycin-induced cases (75% and 68% of cases in the series and literature, respectively) was notably higher than the overall reported incidence in DIHS (10%-40%). The degree of renal impairment was also significantly increased in the retrospective series (a median 4.98-fold change in baseline creatinine level vs a 2.25-fold increase in non–vancomycin-associated cases [P = .011]).

Limitations

The principal limitation of this study is the small sample size. Other notable limitations include the retrospective nature of the study and absence of confirmatory renal biopsies.

Conclusion

Although the current understanding of DIHS/DRESS is imperfect, our findings suggest that vancomycin-induced cases present with a unique phenotype characterized by a higher burden of renal involvement.



中文翻译:

万古霉素相关药物引起的超敏反应综合征

背景

尽管某些药物的超敏反应已得到很好的表征,但尚未定义万古霉素相关的药物诱发的超敏反应综合征(DIHS)或伴有嗜酸性粒细胞增多和全身症状的药物反应(DRESS)。

客观的

为了更好地定义与万古霉素相关的DIHS的临床表型。

方法

在一个单一的学术机构进行了为期8年的回顾性病例系列研究。共鉴定出29例DIHS / DRESS病例,其中4例归因于万古霉素。进行了文献复习;它确定了28例万古霉素诱导的DIHS病例。还审查了与万古霉素相关的急性间质性肾炎,以发现其他先前未发现的全身性超敏反应病例。审查还产生了11个案例。

结果

在本文献回顾和回顾性系列中,万古霉素诱导的病例中肾功能不全的发生率(分别为该系列和文献的75%和68%)明显高于DIHS的总体报道发生率(10%-40%)。 )。在回顾性研究中,肾功能不全的程度也显着增加(基线肌酐水平变化中位数为4.98倍,而与万古霉素无关的病例为2.25倍[ P  = .011])。

局限性

该研究的主要局限性是样本量小。其他显着的局限性包括研究的回顾性和没有确定性的肾活检。

结论

尽管目前对DIHS / DRESS的理解还不完善,但我们的发现表明,由万古霉素引起的病例具有独特的表型,其特征是肾脏受累负担较高。

更新日期:2019-07-07
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