Vancomycin-associated drug-induced hypersensitivity syndrome.
Academic Medical Centers
Adult
Age Factors
Aged
Cohort Studies
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Hypersensitivity Syndrome
/ epidemiology
Eosinophilia
/ chemically induced
Female
Humans
Male
Middle Aged
Prevalence
Prognosis
Retrospective Studies
Risk Assessment
Sex Factors
United States
Vancomycin
/ adverse effects
Young Adult
DIHS
DRESS
drug reaction with eosinophilia and systemic symptoms
drug-induced hypersensitivity syndrome
renal dysfunction
vancomycin
Journal
Journal of the American Academy of Dermatology
ISSN: 1097-6787
Titre abrégé: J Am Acad Dermatol
Pays: United States
ID NLM: 7907132
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
30
07
2018
revised:
13
01
2019
accepted:
01
02
2019
pubmed:
10
2
2019
medline:
26
11
2019
entrez:
10
2
2019
Statut:
ppublish
Résumé
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. To better define the clinical phenotype of vancomycin-associated DIHS. 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. 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]). 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
To better define the clinical phenotype of vancomycin-associated DIHS.
METHODS
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
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
CONCLUSIONS
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
CONCLUSIONS
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.
Identifiants
pubmed: 30738120
pii: S0190-9622(19)30197-5
doi: 10.1016/j.jaad.2019.02.002
pii:
doi:
Substances chimiques
Vancomycin
6Q205EH1VU
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
123-128Informations de copyright
Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.