Ty Gilkey1, John Trinidad2, Claire Kovalchin1, Abena Minta1, Misha Rosenbach3, Benjamin H Kaffenberger2. 1. Mr. Gilkey, Ms. Kovalchin, and Ms. Minta are with the Medical Student Research Program at The Ohio State College of Medicine in Columbus, Ohio. 2. Drs. Kaffenberger and Trinidad are with the Department of Internal Medicine in the Division of Dermatology at The Ohio State University Wexner Medical Center in Columbus, Ohio. 3. Dr. Rosenbach is with the Department of Dermatology at the University of Pennsylvania in Philadelphia, Pennsylvania.
Abstract
Objective: We sought to evaluate medication exposures during an entire hospitalization, with the goal of describing medications and demographic conditions that are associated with developing a drug eruption during hospitalization. Methods: 468 patients that developed a cutaneous drug eruption were identified from a cohort of 18,140 unique inpatients with dermatologic diagnoses; medication lists and demographic information were assimilated, and drug eruption frequency tables were created. Results: The agents most commonly associated with drug eruptions included many antineoplastic, antifungal, and antibiotic therapeutics: idarubicin (27.78% reaction rate), daunorubicin (26.43%), sorafenib (25.00%), lenalidomide (23.53%), all-trans-retinoic acid (22.58%), decitabine (21.57%), aztreonam (15.15%), posaconazole (14.29%), and voriconazole (13.78%) among many others. Patients diagnosed with drug eruptions were more likely to have private insurance (3.29% vs. 2.58% reaction rate) and were on average older (56.7 vs. 52.6 years), had longer inpatient stay (14.2 vs. 7.9 days), and higher inpatient mortality (5.95% vs. 2.58%) than patients without eruptions. Limitations: This was a single-center cross-sectional study. Drug reaction codes were used substantially less frequently than more general codes for non-specific eruptions, further, the analysis was stratified by full hospitalization data to account for delayed reactions. Conclusion: Hospitalizations in which patients receive medications common to malignancies, such as cytotoxic and antifungal therapies represent the highest risk hospitalizations for the development of drug eruptions. When diagnosing and treating drug eruptions, clinicians should consider these medication classes with a high index of suspicion.
Objective: We sought to evaluate medication exposures during an entire hospitalization, with the goal of describing medications and demographic conditions that are associated with developing a drug eruption during hospitalization. Methods: 468 patients that developed a cutaneous drug eruption were identified from a cohort of 18,140 unique inpatients with dermatologic diagnoses; medication lists and demographic information were assimilated, and drug eruption frequency tables were created. Results: The agents most commonly associated with drug eruptions included many antineoplastic, antifungal, and antibiotic therapeutics: idarubicin (27.78% reaction rate), daunorubicin (26.43%), sorafenib (25.00%), lenalidomide (23.53%), all-trans-retinoic acid (22.58%), decitabine (21.57%), aztreonam (15.15%), posaconazole (14.29%), and voriconazole (13.78%) among many others. Patients diagnosed with drug eruptions were more likely to have private insurance (3.29% vs. 2.58% reaction rate) and were on average older (56.7 vs. 52.6 years), had longer inpatient stay (14.2 vs. 7.9 days), and higher inpatient mortality (5.95% vs. 2.58%) than patients without eruptions. Limitations: This was a single-center cross-sectional study. Drug reaction codes were used substantially less frequently than more general codes for non-specific eruptions, further, the analysis was stratified by full hospitalization data to account for delayed reactions. Conclusion: Hospitalizations in which patients receive medications common to malignancies, such as cytotoxic and antifungal therapies represent the highest risk hospitalizations for the development of drug eruptions. When diagnosing and treating drug eruptions, clinicians should consider these medication classes with a high index of suspicion.
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