回顾性分析头孢菌素皮试原则用于头孢菌素类+β-内酰胺酶抑制剂的适用性  

Practicing Cephalosporins skin test prior to Cephalosporins+β-lactamase inhibitors use:A retrospective analysis on rationality and adaptability

作　　者：邱小惠 毛玉巧 苏健芬 张庆[3] Qiu Xiaohui;Mao Yuqiao;Su Jianfen;Zhang Qing(Department of Pharmacy,Panyu Central Hospital,Guangzhou Guangdong 511400,China;Department of Infectious Diseases,Panyu Central Hospital,Guangzhou Guangdong 511400,China;Department of Pharmacy,Nanfang Hospital of Southern Medical University,Guangzhou Guangdong 510515,China)

机构地区：[1]广东省广州市番禺区中心医院药学部,广东广州511400 [2]广东省广州市番禺区中心医院感染科,广东广州511400 [3]南方医科大学南方医院药学部,广东广州510515

出　　处：《中国药物与临床》2023年第1期13-20,共8页Chinese Remedies & Clinics

基　　金：广东省广州市番禺区科技计划项目(2022-Z04-040)。

摘　　要：目的分析头孢菌素皮试原则对头孢菌素类+β-内酰胺酶抑制剂(CBI)的适用性。方法收集广州市番禺区中心医院2019年1月至2021年7月使用CBI患者的病历资料,回顾性分析患者年龄、性别、既往过敏史、CBI皮试情况和结果、过敏情况。根据研究目的对患者进行分组,分别比较3大组别(①皮试阴性组和未皮试组;②既往有过敏史组和既往无过敏史组;③既往青霉素、头孢过敏史组和既往非青霉素、头孢过敏史组)使用CBI后过敏反应发生率的差异。结果纳入病例7771例,共用5种CBI,皮试率81.09%(6302/7771)。皮试阳性率0.11%(7/6302),既往青霉素皮试阳性或过敏患者皮试阳性率85.71%(6/7)。过敏20例(17例为速发型过敏反应,3例为迟发型过敏反应),主要症状均为皮疹和瘙痒,停药及对症处理后好转,后期改用其他种类抗菌药物,均未发生过敏反应;过敏患者中既往有过敏史患者8例(含青霉素、头孢过敏5例);皮试阴性组过敏率0.25%(16/6295),未皮试组过敏率0.27%(4/1469),2组过敏率比较差异无统计学意义(P>0.05)。既往有过敏史组过敏率均比既往无过敏史组高,差异均有统计学意义(P<0.05)。而既往青霉素、头孢过敏史组和既往非青霉素、头孢过敏史组过敏发生率比较差异均无统计学意义(P>0.05)。结论常规皮试对CBI过敏反应无明显的预测价值,但对既往有过敏史患者有参考价值。既往有过敏史的患者,使用CBI发生过敏的风险比既往无过敏史的患者高,其他过敏原导致过敏的风险并不亚于青霉素类或头孢菌素类。头孢菌素皮试原则总体适用于CBI,但最适皮试液浓度及过敏原风险评估标准仍需进一步研究。Objective To determine the adaptability of practicing Cephalosporins skin test prior to Cephalosporins+β-lactamase inhibitors(CBI)use.Methods The medical records of patients admitted to Guangzhou Panyu Central Hospital and on CBI use between January 2019 and July 2021 were included in the study.The age,gender,history of allergies,previous skin test prior to CBI use,and CBI allergy were retrospective-ly analyzed.The patients were stratified into three tiers according to our study objectives,including①those with negative vs no skin tests,②those with vs without a previous history of allergies,and③those with vs without previous allergy to Penicillins and Cephalosporins.The difference in allergic reactions after CBI use was compared among the three tiers,respectively.Results Included in the study were 7771 patients,treated variably on 5 CBI varieties,with 81.09%(6302/7771)undergoing skin test prior to CBI use.The positive rate of skin test was 0.11%(7/6302)overall,or 85.71%(6/7)in those with a previous history of positive skin test or allergy to Peni-cillins.CBI allergy was noted in 20 cases(including 17 of immediate and 3 of delayed allergic reactions)in which rash and pruritus were the main symptoms,resolved after drug withdrawal and symptomatic treatment,and no longer occurred after switching to other antibiotics varieties.Among the patients who presented allergy,there were 8 cases with previous allergy(including 5 previously allergic to Penicillins and/or Cephalosporins).The rate of CBI allergy was 0.25%(16/6295)in patients with negative skin test vs 0.27%(4/1469)in those who did not undergo the skin test,with no statistically significant difference(P>0.05).The rate of CBI allergy was significantly higher in patients with than in those without a previous history of allergy(P<0.05).There was no statistically significant dif-ference in the incidence of CBI allergy between patients with and without a previous history of allergy to Peni-cillins and/or Cephalosporins(P>0.05).Conclusion Routine skin test exhibits

关 键 词：头孢菌素类 皮内试验 Β-内酰胺酶抑制剂 

分 类 号：R978.1[医药卫生—药品]