Clinical characteristics of antimicrobial agent-associated delayed rashes and analysis of its related factors for progression to severe cutaneous adverse reactions
OBJECTIVE To explore the clinical characteristics of patients with delayed rashes on a therapy of antimicrobial agents and examine the related factors for progression to severe cutaneous adverse reactions(SCARs)to provide references for pharmacological monitoring.METHODS Based upon the adverse reaction reports of rashes related to antimicrobial agents from May 2020 to May 2023,basic profiles,allergy history and occurrence and adverse reactions were recorded.The relevant clinical were retrospectively reviewed and then univariate and logistic regression analyses performed.RESULTS A total of 56 patients on a therapy of antimicrobial agents developed delayed rashes.Cephalosporins and glycopeptides had the highest frequency of sensiti-zation(n=13,23.2％)and rashes occurred mostly at Days 2-7 after dosing(n=36,64.3％).Antihistamines were often pre-scribed(n=24,42.9％)and 28-day all-cause mortality after rashes was 14.3％(n=8).They were assigned into two groups of SCARs(n=11)and non-SCARs(n=45).No statistically significant inter-group difference existed in demographic profiles(P＞0.05).Univariate analysis revealed that medication time(Z=-2.281,P=0.023),maximal leucocyte(Z=-2.186,P=0.029),maximal eosinophil(Eos)(Z=-4.138,P＜0.01)and maximal monocyte(Mono)during medication(Z=-2.757,P=0.006)differed significantly between two groups.And multifactorial analysis indicated that maximal Eos during medication(OR=0.030,P=0.004)differed greatly between two groups.Receiver operating characteristic(ROC)curve analysis showed a critical value of 0.255×109L-1 for maximal Eos during medication with an area under the curve of 0.905(0.826-0.984).CONCLUSION Two major antimicrobial agents causing antimicrobial agent-related delayed rashes are cephalosporins and glycopeptides.And Eos dur-ing medication is a related factor for progression to SCARs and it should be monitored closely in clinical practices.
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