NDLI: Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics.

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Peripheral blood eosinophilia and hypersensitivity reactions among patients receiving outpatient parenteral antibiotics.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Blumenthal, Kimberly G. Youngster, Ilan Rabideau, Dustin J. Parker, Robert A. Manning, Karen S. Walensky, Rochelle P. Nelson, Sandra B.
Description	Author Affiliation: Blumenthal KG ( Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass); Youngster I ( Harvard Medical School, Boston, Mass); Rabideau DJ ( Biostatistics Center, Massachusetts General Hospital, Boston, Mass.); Parker RA ( Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass); Manning KS ( Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Mass.); Walensky RP ( Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass); Nelson SB ( Harvard Medical School, Boston, Mass)
Abstract	BACKGROUND: Although drug-induced peripheral eosinophilia complicates antimicrobial therapy, little is known about its frequency and implications. OBJECTIVE: We aimed to determine the frequency and predictors of antibiotic-induced eosinophilia and subsequent hypersensitivity reactions (HSRs). METHODS: We evaluated a prospective cohort of former inpatients receiving intravenous antibiotic therapy as outpatients with at least 1 differential blood count. We used multivariate Cox proportional hazards models with time-varying antibiotic treatment indicators to assess the effect of demographic data and antibiotic exposures on eosinophilia and subsequent HSRs, including documented rash, renal injury, and liver injury. Possible drug rash with eosinophilia and systemic symptoms (DRESS) syndrome cases were identified and manually validated. RESULTS: Of 824 patients (60% male; median age, 60 years; median therapy duration, 41 days), 210 (25%) had eosinophilia, with median peak absolute eosinophil counts of 726/mL (interquartile range, 594-990/mL). Use of vancomycin, penicillin, rifampin, and linezolid was associated with a higher hazard of having eosinophilia. There was a subsequent HSR in 64 (30%) of 210 patients with eosinophilia, including rash (n = 32), renal injury (n = 31), and liver injury (n = 13). Patients with eosinophilia were significantly more likely to have rash (hazard ratio [HR], 4.16; 95% CI, 2.54-6.83; P < .0001) and renal injury (HR, 2.13; 95% CI, 1.36-3.33; P = .0009) but not liver injury (HR, 1.75; 95% CI, 0.92-3.33; P = .09). Possible DRESS syndrome occurred in 7 (0.8%) of 824 patients; 4 (57%) were receiving vancomycin. CONCLUSIONS: Drug-induced eosinophilia is common with parenteral antibiotics. Although most patients with eosinophilia do not have an HSR, eosinophilia increases the hazard rate of having rash and renal injury. DRESS syndrome was more common than previously described.
File Format	HTM / HTML
ISSN	00916749
e-ISSN	10976825
Journal	Journal of Allergy and Clinical Immunology
Issue Number	5
Volume Number	136
Language	English
Publisher	Elsevier
Publisher Date	2015-11-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Immunology Anti-bacterial Agents Administration & Dosage Drug Hypersensitivity Syndrome Epidemiology Allergens Immunology Ambulatory Care Adverse Effects Blood Circulation Cohort Studies Etiology Eosinophils Proportional Hazards Models Prospective Studies Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Immunology and Allergy Immunology

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