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Epidemiology of Drug Eruption:a4-month Prospective Survey in Peking Union Medical College Hospital

Author: TianXiaoYin
Tutor: LiuYueHua
School: Beijing Union Medical College
Course: Clinical
Keywords: drug eruption epidemiology hospitalized patients prospectivesurvey
CLC: R758.25
Type: PhD thesis
Year: 2012
Downloads: 43
Quote: 0
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Abstract


Background:Drug eruptions, usually mediated by immune reactions, are common adverse drug reactions in hospitals. The characteristics of drug eruptions never remain the same with new drugs coming out and people’s disease spectrum changing all the time. As an important part in dermatology, the epidemiology of drug eruption in hospitalized patients is surveyed either retrospectively or prospectively in several countries, including developed and developing countries. However, to the best of our knowledge, no prospective data are available in China.Objective:This study was designed to1) evaluate the incidence of drug eruptions, SCAR and their outcome including mortality rate;2) describe the clinical manifestations and characteristics of patients with drug eruption;3) find out risk factors associated with drug eruption;4) compare our data with those from previous studies.Methods:A4-month prospective study was carried out in Peking Union Medical College Hospital to collect drug eruption cases of inpatients (January2012to April2012). To ensure the integrity of the study, volunteers were recruited from medical students in different wards. Information of newly developed drug eruptions observed by the volunteers, other clinical staff, and dermatology consultation doctors was reported to the contact person of this study. Then a dermatologist reviewed the suspected patient as soon as possible and made a clinical diagnosis. A standard questionnaire was used to collect data of confirmed cases including four parts as followings:demographic data of the patient, lesion morphology description, drug implicated in the reaction, and the treatment information. In the end, data from all cases were analyzed statistically.Results:Sixty-six cases were confirmed as drug eruptions among22866hospitalized patients. An incidence of2.9‰was estimated. Four patients had more than one reactions induced by different drugs. And there were seventy-one reactions in total. At the same time, fifteen patients were admitted to our hospital because of drug eruption. So we had a overall prevalence of3.5‰. Of all the patients,31.8%had had a drug hypersensitivity history before admission, which was statistically higher than those in other inpatients (P<0.01); the main causes of hospitalization were tumor (39.4%), infection (16.7%), cardiovascular and cerebrovascular disease (16.7%). DM/PM was found to have a higher rate of drug eruption (P<0.01) and it is37.4times (CI95%11.1-125.9) that of other hospitalized patients. The incidence was higher in patients hospitalized in internal medical departments than in surgical departments while the infectious department had the highest rate (6.2%). Drug eruptions were not found to be gender or age related in our study. Exanthematous reactions and urticaria were equally the most common drug eruption types. Three reactions were considered to be severe including one case of DIHS, and two cases of anaphylaxis. Drugs most frequently associated with drug eruptions were anti-infection drugs (29.6%), radiographic contrast media (16.9%), blood and blood products (12.7%). The most common anti-infective drugs which induced ADR were cephalosporins. Most of the patients recovered from drug eruption, while one patient probably died from complications related to anaphylaxis (1.5%) and two patients died from associated diseases.Conclusions:1)The survey we carried out finds a overall prevalence of drug eruption close to recent studies in other countries, but lower than the previously reported study from the USA(2%);2) previous drug hypersensitivity history and DM/PM are risk factors of developing a drug eruption (P<0.01);3) As confirmed in other studies, principal imputable drugs are anti-infection drugs while cephalosporins have the highest portion of anti-infection drugs in our study;4) radiographic contrast media, blood and blood products are more often in our hospital with a higher rate of uticaria;5) most patients with drug eruption have a good prognosis and SCAR is rare.

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CLC: > Medicine, health > Dermatology and Venereology > Dermatology > Allergic and toxic skin diseases > Dermatitis ( drug eruption )
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