Antibiotic allergy labels in hospitalized and critically ill adults: A review of current impacts of inaccurate labelling

Abstract

Antibiotic allergy labels (AALs) are reported by approximately 20% of hospitalized patients, yet over 85% will be negative on formal allergy testing. Hospitalized patients with an AAL have inferior patient outcomes, increased colonization with multidrugresistant organisms and frequently receive inappropriate antimicrobials. Hospitalized populations have been well studied but, to date, the impact of AALs on patients with critical illness remains less well defined. We review the prevalence and impact of AALs on hospitalized patients, including those in in critical care. We performed a narrative review, examining literature via the Medline (Ovid) platform (September 2017 and February British Journal of Clinical Pharmacology Br J Clin Pharmacol (2019) 85 492-500 492 Adapted from Trubiano et al. (with permission) [25, 58], Gell and Coombs [16], Pichler [19]. Comparative table of the different type B adverse drug reactions and their immunological components, clinical presentations and time frames. SJS, Stevens-Johnsons syndrome; TEN, toxic epidermal necrosis; DRESS, drug reaction with eosinophilia and systemic symptoms Review of antibiotic allergy impacts in hospitalized adults Br J Clin Pharmacol (2019) 85 492-500 493 Review of antibiotic allergy impacts in hospitalized adults Br J Clin Pharmacol (2019) 85 492-500 499

Controversies in Perioperative Antimicrobial Prophylaxis

“…Additional reasons for increased surgical site infections with vancomycin alone could be the underappreciated role of Gram-negative pathogens in these infections 27 and the greater effectiveness of cephalosporins as compared with glycopeptides for methicillin-sensitive S. aureus. 25 Because 85 to 95% of patients with documented antibiotic allergy have negative skin testing, 28,29 further investigation into the individual reaction would optimize antimicrobial coverage and may decrease the frequency of surgical site infection. Formal allergy testing is feasible in patients with unclear types of reactions to penicillin or cephalosporins who are expected to undergo elective surgery.…”

Prevalence of Antibiotic Allergy Labels in a Tertiary Referral Center in Belgium

“…Indeed, many patients have an AB allergy reported in their medical file, hereafter referred to as an antibiotic allergy label (AAL). Studies in United States of America (US) centers indicate that 10 to 15% of hospitalized and outpatients, respectively, carry one or more AAL (2)(3)(4)(5). However, large-scale European analyses are scarce and primarily focus on penicillin (6)(7)(8)(9)(10)(11).…”

Beta-lactam allergy labeling in intensive care units

“…[ 1 ] In parallel, a β-lactam allergy is reported by at least 10% of patients, whereas 90% of those labeled with this allergy in their medical file are able to tolerate these antibiotics. [ 2 , 3 ] This incorrect labeling can result in antimicrobial treatments that do not adhere to standard recommendations, thereby reducing the treatment success and possibly increasing the risk of multidrug-resistant (MDR) pathogens due to the increased use of drugs like fluoroquinolones. [ 4 ] This situation poses a specific risk in the ICU, in which inappropriate antimicrobial treatments are associated with increased mortality.…”