scholarly journals Tolerability of Cefazolin after Immune-Mediated Hypersensitivity Reactions to Nafcillin in the Outpatient Setting

2014 ◽  
Vol 58 (6) ◽  
pp. 3137-3143 ◽  
Author(s):  
Kimberly G. Blumenthal ◽  
Ilan Youngster ◽  
Erica S. Shenoy ◽  
Aleena Banerji ◽  
Sandra B. Nelson
Keyword(s):  
Bacterial Infections ◽  
Massachusetts General Hospital ◽  
Cohort Analysis ◽  
Maculopapular Rash ◽  
Outpatient Setting ◽  
Hypersensitivity Reactions ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Monitoring Therapy ◽  
Immune Mediated ◽  
Ige Mediated

ABSTRACTThe objective of the present study was to assess the safety and tolerability of cefazolin therapy among patients with methicillin-sensitive Gram-positive bacterial infections who develop non-IgE-mediated hypersensitivity reactions (HSRs) to nafcillin. In this retrospective cohort analysis of the Outpatient Parenteral Antimicrobial Therapy program at the Massachusetts General Hospital from 2007 through 2013, we identified patients switched from nafcillin to cefazolin after an immune-mediated HSR. We reviewed patient demographics, details about the original HSR, and outcomes after the switch to cefazolin therapy. HSRs were classified by reaction type and likely mechanism. There were 467 patients treated with nafcillin, of which 60 (12.8%) were switched to cefazolin during their prescribed course. Of the 60 patients who transitioned to cefazolin, 17 (28.3%) were switched because of non-IgE-mediated HSRs. HSRs included maculopapular rash (n= 10), immune-mediated nephritis (n= 3), isolated eosinophilia (n= 2), immune-mediated hepatitis (n= 1), and a serum sickness-like reaction (n= 1). All but one patient (94.1%) who switched to cefazolin tolerated the drug with resolution of the HSR and completed their therapy with cefazolin. No patient experienced worsening of their rash or progressive organ dysfunction. With appropriate monitoring, therapy with cefazolin after non-IgE-mediated HSRs to nafcillin appears to be safe.

scholarly journals Antibiotic Hypersensitivity Mechanisms

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 122 ◽  
Author(s):  
Jenana H. Maker ◽  
Cassandra M. Stroup ◽  
Vanthida Huang ◽  
Stephanie F. James
Keyword(s):  
Bacterial Infections ◽  
Signs And Symptoms ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Type Iv ◽  
Immune Mediated ◽  
Different Types ◽  
Ige Mediated ◽  
Antibiotic Reactions ◽  
Immune Complex Formation

Antibiotics are commonly prescribed to treat a variety of bacterial infections. As with all medications, hypersensitivity reactions may occur and clinicians should be able to recognize them accurately and recommend appropriate management. Antibiotic related hypersensitivity reactions may be one of four different types: Type I reactions, which are IgE mediated and may lead to anaphylaxis; Type II reactions that are antibody-mediated and may result in thrombocytopenia, neutropenia, or hemolytic anemia; Type III reaction that involves an immune complex formation such as vasculitis; and Type IV reactions that consist of four subtypes and typically include a rash of varying level of severity with or without systemic signs and symptoms. Herein, we describe the mechanisms of different types of allergic reactions to commonly prescribed antibiotics and offer recommendations for management. Further, we briefly refer to antibiotic reactions that mimic hypersensitivity reactions but are not immune mediated, such as pseudoallergies and serum sickness-like reactions.

Immediate reaction to ibrutinib amenable to oral desensitization

2021 ◽  
pp. 107815522110046
Author(s):  
Neelam A Phadke ◽  
Samantha O Luk ◽  
Ephraim P Hochberg ◽  
Aleena Banerji
Keyword(s):  
Maculopapular Rash ◽  
Chemotherapeutic Agents ◽  
Lymphocytic Leukemia ◽  
Hypersensitivity Reactions ◽  
First Line ◽  
Management Guidelines ◽  
Cutaneous Hypersensitivity ◽  
Ige Mediated ◽  
To Receive ◽  
Oral Desensitization

Introduction Although up to half of patients receiving chemotherapeutic agents develop hypersensitivity reactions to the same, desensitization protocols can induce temporary tolerance to allow patients to continue to receive first-line treatment. Approximately 25% of patients develop cutaneous hypersensitivity reactions to ibrutinib, but there are no published management guidelines. Case report We describe the case of a 71-year-old woman with chronic lymphocytic leukemia who developed a delayed maculopapular rash with lip tingling and swelling following ibrutinib therapy. Management and outcome We performed a novel 11-step desensitization procedure to ibrutinib allowing us to successfully induce tolerance against IgE-mediated symptoms in this patient. Discussion As indications for ibrutinib use expand and more patients present with IgE-mediated symptoms, we expect that this protocol will provide benefit for many such patients.

scholarly journals Ketorolac induced non allergic angioedema: A case report

2020 ◽  
Vol 11 (3) ◽  
pp. 4342-4346
Author(s):  
Chinju ◽  
Mahesh P A ◽  
Shilpa Palaksha
Keyword(s):  
Early Recognition ◽  
Hypersensitivity Reactions ◽  
Lipoxygenase Pathway ◽  
Immunological Mechanism ◽  
Immune Mediated ◽  
Different Types ◽  
Diagnostic Difficulties ◽  
Adults And Children ◽  
Ige Mediated ◽  
Inflammatory Drugs

Non- Steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed category of drugs. NSAIDs are the main cause of allergic reactions both in adults and children. Hypersensitivity reactions due to NSAIDs involve 0.3% to 0.5% of the overall population. Among the different types of NSAIDs induced hypersensitivity reactions, urticaria and angioedema are the most common. Angioedema can be of two types, allergic(IgE) & Nonallergic( Non IgE) mediated. Allergic angioedema is immune mediated but non allergic angioedema mimic immune mediated allergic reaction without underlying evidence of immunological mechanism which can cause diagnostic difficulties for the clinician. Distinguishing immune-mediated and non-immune-mediated reactions can be difficult, so careful evaluation is needed. Pathomechanism of NSAIDs induced non allergic angioedema is based on cysteniyl leukotrienes and bradykinin pathway in which NSAIDs block cyclo oxygenase pathway and directs the lipoxygenase pathway and generates leukotrienes which result in the development of angioedema. NSAIDs induced allergic angioedema is quite frequent and NSAIDs induced nonallergic angioedema are quite rare.The detailed information of these reactions is necessary to decrease morbidity and mortality associated with the reactions.The early recognition and discontinuation of suspected drug should be done in order to avoid further complications. Here, we report a case of a patient with non allergic angioedema in association with use of Ketorolac.

scholarly journals Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections

2020 ◽  
Vol 7 ◽  
Author(s):  
Tristan Ferry ◽  
Thomas P. Lodise ◽  
Jason C. Gallagher ◽  
Emmanuel Forestier ◽  
Sylvain Goutelle ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Bacterial Infections ◽  
Healthcare Delivery ◽  
Standard Of Care ◽  
Healthcare Services ◽  
Outpatient Setting ◽  
Tolerability Profile ◽  
Local Tolerability ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
At Home

Since the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has been a viable option for patients who require intravenous antibiotics when hospitalization is not warranted. While the benefits of OPAT as a measure to improve the efficiency of healthcare delivery (i.e., reduced hospital days) and patient satisfaction are well-documented, OPAT is associated with a number of challenges, including line complications and reliance on daily healthcare interactions in some cases at home or in a clinic. To minimize the continued need for intensive healthcare services in the outpatient setting, there is trend toward patients self-administering antibiotics at home without the presence of healthcare workers, after adequate training. In most cases, patients administer the antibiotics through an established intravenous catheter. While this OPAT practice is becoming more accepted as a standard of care, the potential for line complications still exists. Outpatient subcutaneous antimicrobial therapy (OSCAT) has become an increasingly accepted alternative route of administration of antibiotics to IV by French infectious diseases physicians and geriatricians; however, currently, no antibiotics are approved to be administered subcutaneously. Antibiotics with longer half-lives that are completely absorbed and have a favorable local tolerability profile are ideal candidates for OSCAT and have the potential to maximize the quality and efficiency of parenteral antibiotic delivery in the outpatient setting. The increasing development of wearable, on-body subcutaneous delivery systems make OSCAT even more viable as they increase patient independence while avoiding line complications and potentially removing the need for direct healthcare professional observation.

scholarly journals Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Victor Garcia-Bustos ◽  
Ana Isabel Renau Escrig ◽  
Cristina Campo López ◽  
Rosario Alonso Estellés ◽  
Koen Jerusalem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Incontinence ◽  
Multidrug Resistance ◽  
Urinary Tract ◽  
Prospective Cohort ◽  
Bacterial Infections ◽  
Cohort Analysis ◽  
Term Care ◽  
Hospitalised Patients ◽  
Tract Infections

AbstractUrinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17–29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00–12.50) and urinary incontinence (OR 2.63, 95% CI 1.04–6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.

scholarly journals HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

2004 ◽  
Vol 17 (2) ◽  
pp. 348-369 ◽  
Author(s):  
Inés Colmegna ◽  
Raquel Cuchacovich ◽  
Luis R. Espinoza
Keyword(s):  
Reactive Arthritis ◽  
Bacterial Infections ◽  
The Body ◽  
Current Evidence ◽  
Intracellular Bacteria ◽  
Molecular Pathways ◽  
Hla B27 ◽  
Immune Mediated ◽  
Clinical Considerations ◽  
Active Bacteria

SUMMARY Current evidence supports the concept that reactive arthritis (ReA) is an immune-mediated synovitis resulting from slow bacterial infections and showing intra-articular persistence of viable, nonculturable bacteria and/or immunogenetic bacterial antigens synthesized by metabolically active bacteria residing in the joint and/or elsewhere in the body. The mechanisms that lead to the development of ReA are complex and basically involve an interaction between an arthritogenic agent and a predisposed host. The way in which a host accommodates to invasive facultative intracellular bacteria is the key to the development of ReA. The details of the molecular pathways that explain the articular and extra-articular manifestations of the disease are still under investigation. Several studies have been done to gain a better understanding of the pathogenesis of ReA; these constitute the basis for a more rational therapeutic approach to this disease.

Relationship between insurance status and diagnosis of cutaneous immune-related adverse events.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18535-e18535
Author(s):  
Michael Chang ◽  
Nira A. Krasnow ◽  
Amy E. Blum ◽  
Vartan Pahalyants ◽  
William S. Murphy ◽  
...  
Keyword(s):  
Linear Regression ◽  
Adverse Events ◽  
Massachusetts General Hospital ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Multivariable Analysis ◽  
Maculopapular Rash ◽  
Insurance Status ◽  
Billing Data ◽  
Delays In Diagnosis

e18535 Background: Cutaneous immune-related adverse events (cirAEs) are among the most common side effects of immune checkpoint inhibitor (ICI) therapy. While insurance status has been shown to influence outcomes in patients treated with ICIs, its impact on cirAE management remains underexplored. We therefore evaluated insurance status in patients with cirAEs, examining its effect on rate of and time to cirAE diagnosis. Methods: Using billing data, we retrospectively identified patients who initiated anti-PD-1/PDL-1 and/or anti-CTLA-4 therapy at Massachusetts General Hospital between January 1, 2016 and March 8, 2019 (n = 2,459) for possible cirAE. Eligible cirAEs included reactions attributed to ICI by the clinician, consistent with established morphologic categories. For each patient with confirmed cirAE (n = 358), we abstracted oncologic history, cirAE features, and insurance status. Associations between insurance and cirAE diagnosis outcomes were assessed via logistic and linear regression, and adjusted for age, sex, race, ICI type, cancer diagnosis, cirAE type, and significant covariates ( P< 0.05). Results: Of the 2,459 patients who received ICIs, 2,419 (98.4%) had documented insurance status. Most ICI recipients had Medicare (n = 1,119; 46.3%) or private insurance (n = 1,156; 47.8%) relative to Medicaid (n = 104; 4.3%) or other government insurance (e.g. Tricare) (n = 40; 1.7%). We found that 358 (median age 64 years, 40.5% female) developed a cirAE. Among cirAE patients, 175 had Medicare (48.9%), 174 had private insurance (48.6%), 6 had Medicaid (1.7%), and 3 had other government insurance (0.8%). The most common cirAEs across insurance types were maculopapular rash, pruritus, and eczematous and lichenoid eruptions. In the multivariable analysis, ICI patients with Medicare insurance had a higher rate of cirAE diagnosis (adjusted odds ratio: 2.41, 95% CI: 1.00, 5.90, P= 0.05) relative to Medicaid patients. In addition, in terms of time to cirAE diagnosis at dermatology visit, Medicare insurance was associated with longer delays, with a linear regression coefficient of 132.2 (95% CI: 4.78, 259.6; P= 0.04). No significant associations were found between other insurance types and cirAE diagnosis outcomes. Conclusions: Our study shows that patients with Medicaid are less likely to be diagnosed with cirAE relative to those with Medicare, despite delays in diagnosis, when controlling for all other demographic/oncologic factors. Ultimately, these findings are reassuring that despite insurance differences, patients with cirAEs are receiving suitable care and appropriately seen by dermatologists. As insurance coverage for specialists can vary widely, these initial findings are a promising indicator that patients with cirAEs are well-connected within healthcare systems.

Risk Factors Associated With Nephrotoxicity During Outpatient Intravenous Vancomycin Administration

2021 ◽  
pp. 875512252110543
Author(s):  
Karen M. Krueger ◽  
Lisa LaCloche ◽  
Amy Buros Stein ◽  
Ryan Kates ◽  
Milena Murray ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Outpatient Setting ◽  
Intravenous Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Intravenous Antibiotics ◽  
Vancomycin Trough ◽  
Control Study

Background: Many studies have described an association between intravenous vancomycin and nephrotoxicity; however, the majority have evaluated incidence and risk factors among hospitalized patients. Outpatient administration of intravenous antibiotics is a growing practice and presents its own set of unique challenges. Objective: The aim of this study was to identify risk factors for vancomycin-associated nephrotoxicity in the outpatient setting. Methods: A case-control study of patients who received intravenous vancomycin through an Outpatient Parenteral Antimicrobial Therapy (OPAT) program was conducted. Patients were identified who developed an acute kidney injury (AKI) during treatment. The primary outcome was the incidence of AKI during treatment. Results: A total of 37 out of 130 patients (28.5%) met the criteria for AKI. AKI was more likely to occur in patients with a longer duration of therapy, higher maximum trough concentration, co-administration of a fluoroquinolone or metronidazole, and those who received another potentially nephrotoxic medication. Co-administration of a fluoroquinolone (OR = 5.96, P = 0.009, [CI: 1.59, 24.38]), any nephrotoxic medication (OR = 11.17, P < 0.001, [CI 3.14, 51.23]), and a higher maximum vancomycin trough (OR = 1.29, P < 0.001, [CI 1.17, 1.44]) were all indicative of a higher odds of an AKI. Conclusion: In this cohort, vancomycin-associated nephrotoxicity was common during outpatient intravenous antibiotic therapy. Co-administration of a fluoroquinolone, any nephrotoxic medication, and a higher maximum vancomycin trough were associated with AKI development. Further study is needed to determine how this impacts long-term clinical outcomes and what measures can be taken to reduce nephrotoxicity risk.

scholarly journals Clinical Outcomes of Antipseudomonal vs. Non-Antipseudomonal Therapy in Patients with Osteomyelitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S97-S97
Author(s):  
Jeffrey W Jansen ◽  
Ryan P Moenster
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Cohort Analysis ◽  
Anatomical Site ◽  
Clinical Failure ◽  
Primary Analysis ◽  
Exclusion Criteria ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Retrospective Cohort Analysis ◽  
Culture Negative

Abstract Background Osteomyelitis (OM) in diabetics is frequently a polymicrobial infection that rarely involves Pseudomonas (4–5% of cases). Bone cultures have a low-positive yield of 34–50% and, as a result, many patients receive antimicrobial regimens which include antipseudomonal (AP) therapy. Methods A retrospective cohort analysis of adult Veterans with OM treated with AP compared with non-antipseudomonal (NAP) therapy was conducted. Patients managed by the VA St. Louis outpatient parenteral antimicrobial therapy (OPAT) service from 1/1/2009 to 7/31/2015 were identified and screened for inclusion. Patients with culture negative (CN) or non-pseudomonal superficial swab cultures (SCx) were included. Figure 1 presents the study profile and exclusion criteria. The primary outcome was clinical failure, defined as a composite of: (1) extension of antibiotics beyond 1 week of the planned duration, (2) recurrence of OM at the same anatomical site within 12 months, or (3) any unplanned surgery or amputation at the anatomical site within 12 months of ABx completion. Results Overall, 104 patients with 109 OM encounters were included; there were 29 CN encounters and 80 SCx encounters. Table 1 presents baseline demographics. The overall failure rate was 55/109 (50.5%). The results of the analysis are shown in Table 2. While not included in the primary analysis, Pseudomonas was isolated from 8/88 (9.1%) swab cultures and 5/33 (15%) deep cultures. Conclusion Empiric AP therapy did not improve clinical outcomes in patients with either CN or SCx OM. Disclosures All authors: No reported disclosures.

scholarly journals Beta-lactam allergy in the paediatric population

2020 ◽  
Vol 25 (1) ◽  
pp. 62-62 ◽  
Author(s):  
Tiffany Wong ◽  
Adelle Atkinson ◽  
Geert t’Jong ◽  
Michael J Rieder ◽  
Edmond S Chan ◽  
...  
Keyword(s):  
Paediatric Population ◽  
Outpatient Setting ◽  
Stevens Johnson Syndrome ◽  
Beta Lactam ◽  
Antibiotic Resistant ◽  
Beta Lactam Antibiotics ◽  
Johnson Syndrome ◽  
Ige Mediated ◽  
Systemic Symptoms ◽  
Exanthematous Pustulosis

Abstract Beta-lactam allergy is commonly diagnosed in paediatric patients, but over 90% of individuals reporting this allergy are able to tolerate the medications prescribed after evaluation by an allergist. Beta-lactam allergy labels are associated with negative clinical and administrative outcomes, including use of less desirable alternative antibiotics, longer hospitalizations, increasing antibiotic-resistant infections, and greater medical costs. Also, children with true IgE-mediated allergy to penicillin medications are often advised to avoid all beta-lactam antibiotics, including cephalosporins, which is likely unnecessary in greater than 97% of those reporting penicillin allergies. Most patients can be safely treated with penicillin or amoxicillin if they do not have a history compatible with IgE-mediated or systemic, delayed reactions such as Stevens-Johnson syndrome (SJS), serum sickness-like reactions, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, or acute generalized exanthematous pustulosis (AGEP). Guidance is provided on how to stratify risk of beta-lactam allergy, and on test dosing and monitoring in the outpatient setting for patients deemed low risk. Guidance for patients at higher risk of beta-lactam allergy includes criteria for appropriate referral to allergists and the use of alternative antimicrobials, such as cephalosporins, while awaiting specialist assessment.

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