背景:在亚洲人群中,抗生素使用与史蒂文斯-约翰逊综合征(SJS)和中毒性表皮坏死松解症(TEN)的风险之间缺乏关联的证据。
目的:我们评估了SJS/TEN与日本不同抗生素类别相关的风险。
方法:我们使用索赔数据库进行了病例交叉研究。Firth条件逻辑回归用于估计56天危险期与三个对照期与抗生素使用相关的SJS/TEN的比值比(OR)和95%置信区间(CI)。我们为每个抗生素类别创建了18个队列,并计算了每100,000个新用户56天的累积发病率。在每种情况下,还使用表皮坏死溶解症(ALDEN)的药物因果关系算法评估了抗生素类别与SJS/TEN之间的关联。
结果:我们的病例交叉研究包括170例SJS/TEN病例。观察到lincomycins的OR增加(33.00[3.74-4332.05]),甲氧苄啶-磺胺甲恶唑(21.20[6.73-105.98]),青霉素(14.39[6.95-34.21]),糖肽(14.37[3.17-136.10]),头孢菌素(或,7.06[95%CI,4.25-12.21]),氨基糖苷类(6.55[1.97-26.84]),喹诺酮类药物(5.98[3.34-11.20]),磷霉素(5.40[1.20-30.97]),碳青霉烯类(5.09[1.85-15.64]),四环素(4.95[1.78-15.27]),和大环内酯类(3.78[2.13-6.83])。甲氧苄啶-磺胺甲恶唑的SJS/TEN累积发生率为67.4,86.2用于糖肽,低于10.0的其他人。尽管发病率很高,只有2例与糖肽有可能的因果关系.
结论:一些抗生素类别,包括Lincomycins,糖肽,氨基糖苷类,磷霉素,和碳青霉烯类,新建议与SJS/TEN风险相关;考虑甲氧苄啶-磺胺甲恶唑和糖肽的高发病率,这些发现在临床实践中值得谨慎.
Evidence is lacking on the association between antibiotic use and risk of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in Asians.
We assessed the risk of SJS/TEN associated with different antibiotic classes in Japanese.
We conducted a
case-crossover study using a claims database. Firth conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of SJS/TEN associated with antibiotic use in a 56-day hazard period versus 3 control periods. We created 18 cohorts for each antibiotic class and calculated 56-day cumulative incidence per 100,000 new users. The association between antibiotic class and SJS/TEN was also evaluated in each
case using the ALgorithm of Drug causality for Epidermal Necrolysis (ALDEN).
Our
case-crossover study included 170 SJS/TEN cases. Increased ORs were observed for lincomycins (OR, 33.00 [95% CI, 3.74-4332.05]), trimethoprim-sulfamethoxazole (21.20 [6.73-105.98]), penicillins (14.39 [6.95-34.21]), glycopeptides (14.37 [3.17-136.10]), cephalosporins (7.06 [4.25-12.21]), aminoglycosides (6.55 [1.97-26.84]), quinolones (5.98 [3.34-11.20]), fosfomycin (5.40 [1.20-30.97]), carbapenems (5.09 [1.85-15.64]), tetracyclines (4.95 [1.78-15.27]), and macrolides (3.78 [2.13-6.83]). Cumulative incidence of SJS/TEN was 67.4 for trimethoprim-sulfamethoxazole, 86.2 for glycopeptides, and below 10.0 for the others. Despite the high incidence, only 2 cases had a probable causal relationship with glycopeptides.
Some antibiotic classes, including lincomycins, glycopeptides, aminoglycosides, fosfomycin, and carbapenems, were newly suggested to be associated with risk of SJS/TEN; considered together with the high incidence for trimethoprim-sulfamethoxazole and glycopeptides, these findings warrant caution in clinical practice.