Objectives: To investigate the incidence and influencing factors of allergic reactions to cephalosporins.
Methods: A cross-sectional study of 29 medical institutions in Zhejiang Province was conducted from April 2021 to June 2021. The incidence of allergic reactions to cephalosporins was investigated, and the influencing factors of cephalosporin-induced allergic reactions were analyzed by Poisson regression.
Results: A total of 56 155 patients were included in this study. The total incidence of allergic reactions to cephalosporin was 1.67‰, the highest incidence of anaphylaxis occurred for ceftizoxime (4.27‰), followed by ceftriaxone (3.49‰) and cefotaxime (2.40‰). There was no significant difference in the incidence of allergic reactions between patients with negative skin tests and those without skin tests (1.75‰ vs. 1.63‰, RR=1.07, 95%CI: 0.70-1.63, P>0.05). Poisson regression showed that body mass index (BMI) <18.5 kg/m2 (RR=2.43, 95%CI: 1.23-4.82, P<0.05) and history of β-lactam antibiotics allergy (RR=33.88, 95%CI: 1.47-781.12, P<0.05) increased cephalosporin-induced anaphylaxis. Compared with cefuroxime, the risk of allergic reactions was increased for ceftriaxone (RR=3.08, 95%CI: 1.70-5.59, P<0.01), ceftazidime (RR=1.89, 95%CI: 1.03-3.47, P<0.05), and ceftizoxime (RR=3.74, 95%CI: 1.64-8.50, P<0.01).
Conclusions: Lower BMI and history of β-lactam antibiotics allergy increase the risk of cephalosporin allergic reactions. The routine skin test may not reduce the occurrence of allergic reactions to cephalosporins.
目的: 分析头孢菌素类药物过敏反应的发生率及其影响因素。方法: 横断面调研2021年4月1日至6月30日浙江省29家医疗机构所有接受静脉注射头孢菌素类药物的患者，统计头孢菌素类药物过敏反应的发生率，采用泊松回归模型分析头孢菌素类药物诱导过敏反应发生的相关影响因素。结果: 研究共纳入56 155例患者，头孢菌素类药物过敏反应总发生率为1.67‰，过敏反应发生率最高的是头孢唑肟（4.27‰），其次是头孢曲松（3.49‰）和头孢噻肟（2.40‰）。与皮试阴性组比较，非皮试组患者过敏反应发生率无明显增加（分别为1.75‰与1.63‰，RR=1.07，95%CI：0.70~1.63，P>0.05）。泊松回归分析结果显示，体重指数低于18.5 kg/m2（RR=2.43，95%CI：1.23~4.82，P<0.05）、其他β-内酰胺类药物过敏史（RR=33.88，95%CI：1.47~781.12，P<0.05）会增加头孢菌素类药物过敏反应的发生率，且与头孢呋辛比较，头孢曲松（RR=3.08，95%CI：1.70~5.59，P<0.01）、头孢他啶（RR=1.89，95%CI：1.03~3.47，P<0.05）和头孢唑肟（RR=3.74，95%CI：1.64~8.50，P<0.01）过敏反应发生的风险增加。结论: 头孢菌素类药物过敏反应与低体重指数和β-内酰胺类药物过敏史有关，头孢菌素类药物的常规皮试筛查并不能减少过敏反应发生。.
Keywords: Anaphylaxis; Body mass index; Cephalosporin; Skin test; β-lactam antibiotics.