Antibiotic Use in Patients With β-Lactam Allergies and Pneumonia: Impact of an Antibiotic Side Chain–Based Cross-Reactivity Chart Combined With Enhanced Allergy Assessment

Abstract

Background β-lactam antibiotics with dissimilar R-group side chains are associated with low cross-reactivity. Despite this, patients with β-lactam allergies are often treated with non-β-lactam alternative antibiotics. An institutional β-lactam side chain–based cross-reactivity chart was developed and implemented to guide in antibiotic selection for patients with β-lactam allergies. Methods This single-center, retrospective cohort study analyzed the impact of the implementation of the cross-reactivity chart for patients with pneumonia. Study time periods were defined as January 2013 to October 2014 prior to implementation of the chart (historical cohort) and January 2017 to October 2018 (intervention cohort) following implementation. The primary outcome was the incidence of β-lactam utilization between time periods. Propensity-weighted scoring and interrupted time-series analyses compared outcomes. Results A total of 341 and 623 patient encounters were included in the historical and intervention cohorts, respectively. There was a significantly greater use of β-lactams in the intervention cohort (70.4% vs 89.3%; P < .001) and decreased use of alternative therapy (58.1% vs 36%; P < .001). There was no difference in overall allergic reactions between cohorts (2.4% vs 1.6%; P = .738) or in reactions caused by β-lactams (1.3% vs 0.9%; P = .703). Inpatient mortality increased (0% vs 6.4%; P < .001); however, no deaths were due to allergic reactions. Healthcare facility–onset Clostridioides difficile infections decreased between cohorts (1.2% vs 0.2%; P = .032). Conclusions Implementation of a β-lactam side chain–based cross-reactivity chart and enhanced allergy assessment was associated with increased use of β-lactams in patients with pneumonia without increasing allergic reactions.

A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications for Hospitalized Patients in 2021

“…However, the risk of cross-reactivity among BLs has historically been overestimated, and rates of cross-reactivity are lower among BLs with dissimilar R-group side chains [ 14 , 15 ]. Collins and colleagues sought to compare the incidence of BL use among adult patients with documented pneumonia and BL allergy pre- and postimplementation of a side chain cross-reactivity chart in 2014 created by a multidisciplinary team [ 16 ]. The chart provided information based on type and severity of allergy and likelihood of cross-reactivity based on side chains.…”

Significant Publications on Infectious Diseases Pharmacotherapy in 2021

“…Collins et al Antibiotic use in patients with beta-lactam allergies and pneumonia: Impact of an antibiotic side-chainbased cross-reactivity chart combined with enhanced allergy assessment 24 Management of pneumonia may include utilization of β-lactam or non-β-lactam-based regimens. Avoidance of β-lactam antibiotics in patients with reported β-lactam allergies is common despite data showing higher rates of clinical failure and more adverse events with non-β-lactam-based regimens.…”

“…Tables 1 and 2 list the top 20 general ID and top 5 HIV/AIDS articles, respectively. 15-39 Below are the summaries for the 11 publications (10 general ID and 1 HIV/AIDS) which received the highest number of votes, listed alphabetically by the lead author’s last name. Table 3 highlights the key takeaway from each of these 11 publications.…”

“…Collins et al Antibiotic use in patients with beta-lactam allergies and pneumonia: Impact of an antibiotic side-chain-based cross-reactivity chart combined with enhanced allergy assessment 24…”

Antibiotic choice for Group B Streptococcus prophylaxis in mothers with documented penicillin allergies and associated newborn outcomes

“…[8,9] Alternative antibiotics, such as clindamycin and vancomycin, are often used for patients who report a penicillin allergy even though most have low-risk allergies or do not have a confirmed true allergy [10]. Inappropriate use of beta-lactam alternatives has been associated with worse outcomes for non-pregnant patients and increased healthcare utilization costs, [11][12][13] In pregnant patients, being labeled with a penicillin allergy has been associated with increased morbidity including increased risk of cesarean delivery, wound complications, and longer length of hospital stay [14]. However, less is known about the impact of a beta-lactam allergy label neonatal outcomes in the setting of GBS prophylaxis.…”