Table 2.
Study No. | Age-Sex | ICHa | SCAR Phenotype |
Culprit antibiotics(s) | Ex vivo or in vivo positive | Antibiotic use post testing | ||
---|---|---|---|---|---|---|---|---|
Status | Immunosuppression | Antibiotic(s) | Phenotypic Scoreb | |||||
S1 | 72F | N | DRESS | CEF, VAN | 6 | Yes | VAN, AMP, FLU | |
S2 | 20M | N | TEN | TEIC | 4 | Yes | FLU | |
MER | 4 | |||||||
VAN | 4 | |||||||
S3 | 43M | N | SJS | TMP-SMXc | 5 | No | NIL | |
S4 | 48M | N | DRESS | TMP-SMX | 4 | No | DOX | |
S5 | 83M | Y | ITP/Prednisolone | SJS | CEF | 4 | No | MER, DOX, CIP, VAN |
PIP-TAZ | 3 | |||||||
S6 | 38F | N | DRESS | PIP-TAZ, VAN | 7 | Yes | CEFU | |
S7 | 74M | N | DRESS | CEFZ, MER, PENG | 5 | Yes | PENV, FLU | |
S8 | 62M | Y | NHL | DRESS | PIP-TAZ | 4 | Yes | CEPH |
S9 | 57M | Y | AML/chemotherapy | DRESS | VAN, PIP-TAZ, MER | 6 | Yes | PIP-TAZ, MER |
S10 | 51F | N | DRESS | VANC, CEFZ | 6 | Yes | NIL | |
S11 | 59F | N | DRESS | AMP | 4 | Yes | NIL | |
S12 | 52F | N | DRESS | VAN, PIP-TAZ, ADF | 4 | Yes | ADF, MER | |
S13 | 53F | N | AGEP1 | MET | 8 | Yes | PENV | |
AGEP2 | VAN, CIP | |||||||
S14 | 60M | Y | AML/chemotherapy | DRESS | VAN, PIP-TAZ | 4 | No | CIP |
S15 | 58M | N | DRESS | VAN, CIP | 6 | Yes | PENV | |
S16 | 75M | Y | DRESS/Prednisolone | DRESS | VAN, PIP-TAZ | 2 | Yes | CEPH |
S17 | 66M | Y | HCL | DRESS | TMP-SMXc | 4 | Yes | NIL |
S18 | 71M | N | DRESS | PIP-TAZ, AMP | 2 | Yes | AMP | |
S19 | 54F | N | SJS | VAN | 4 | Yes | PENG |
Abbreviations: ICH, immunocompromised host; SCAR, Severe Cutaneous Adverse Drug Reaction; N, no; Y, yes; ITP, immune mediated thrombocytopenia; NHL, non-Hodgkin lymphoma; AML, acute myeloid leukemia; DRESS, drug reaction with eosinophilia and systemic symptoms; HCL, hairy cell leukemia; M, male; F, female; AMP, ampicillin; ADF, amoxicillin clavulanate; CEF, ceftriaxone; CEFZ, cefazolin, CEFU, cefuroxime; CEFT, ceftazidime; CEPH, cephalexin; CIP, ciprofloxacin; FLU, flucloxacillin; MER, meropenem; MET, metronidazole; PENG, benzylpenicillin; PENV, penicillin VK; PIP-TAZ, piperacillin-tazobactam; TEIC, teicoplanin; VAN, vancomycin; 4NO, 4-Nitro sulfamethoxazole; TMP, trimethoprim, SMX, sulfamethoxazole; TMP-SMX, trimethoprim-sulfamethoxazole; FLU, flucloxacillin; Nil, no antibiotics required; DOX, doxycycline
ICH: Transplant recipient, haematological or oncological malignancy (last 5 years), steroids > 10mg prednisolone equivalent per day, connective tissue or autoimmune condition. Immunosuppression was defined as that the patient was receiving at time of PBMC collection.
Phenotypic scores as per published guidelines for SJS/TEN (ALDEN), DRESS (RegiSCAR) and AGEP.
Patient S3 had ibuprofen implicated in causality, ALDEN score (3) was lower than that of TMP-SMX. Patient S18 had cladribine and allopurinol implicated, also with lower ALDEN scores (3) that TMP-SMX.