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

• Published in: The World Allergy Organization journal Vol. 16; no. 1; p. 100738
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2023; Elsevier BV; World Allergy Organization; Elsevier
• Subjects: Allergies; Antibacterial agents; Antibiotics; Beta-lactams; Body mass index; Disease; Drug hypersensitivity syndrome; Drugs; FDA approval; Fever; Full-Length; Hospitalization; Medical records; Patients; Scars; Skin; Statistical analysis; Steroids; Stevens-Johnson syndrome; Toxic epidermal necrolysis; Drug hypersensitivity syndrome; Stevens-Johnson syndrome; Toxic epidermal necrolysis; Beta-lactams; Antibacterial agents
• DOI: 10.1016/j.waojou.2022.100738
• EISSN: 1939-4551

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.
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.
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).
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.