Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia

Turner, Nicholas; Moehring, Rebekah W.; Sarubbi, Christina; Wrenn, Rebekah; Drew, Richard H.; Cunningham, Coleen K.; Fowler, Vance G.; Anderson, Deverick J.

doi:10.1093/ofid/ofy042

Cited by 19 publications

(27 citation statements)

References 33 publications

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“…Of the 20 studies examining LOS, 11 (55%) found that allergy-labeled patients had significantly longer LOS. 2,19,20,25,29,30,[36][37][38][39][40] Also, 8 studies found equivocal results and 1 found that allergy-labeled patients were hospitalized for shorter duration. 17,21,23,24,[31][32][33]41,42 Of 6 studies, 1 (17%) found that allergylabeled patients were more likely to be admitted to the ICU, but all other studies reported no difference (Table 3).…”

Section: Antibiotic Allergy Labels and Clinical Outcomesmentioning

confidence: 99%

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The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: A systematic review

Krah

Jones

Lake

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: A growing body of evidence suggests that antibiotic allergy labels as documented in medical records are a risk factor for poor clinical outcomes. In this systematic review, we aimed to determine how antibiotic allergy labels influence 3 domains: antibiotic use and exposure, clinical outcomes, and healthcare-related costs. Design: We performed a systematic review to identify studies reporting outcomes in patients with antibiotic allergy labels compared to nonallergic counterparts. The search included PubMed, EMBASE, Cochrane CENTRAL, EBSCO, Cochrane Database of Abstracts of Reviews of Effects and Web of Science. Two reviewers independently screened studies for inclusion and abstracted data. Studies were graded using the Newcastle-Ottawa quality assessment scale. Study outcomes included antibiotic use, clinical outcomes, and economic outcomes. Results: In total, 41 studies met our criteria for inclusion. These studies varied in medical specialty, patient population, healthcare delivery system, and design, but most were conducted among adults age >18 years (85%) in the inpatient setting (82.5%). Among 34 studies examining antibiotic exposure, 32 (94%) found that patients with antibiotic allergy labels received more broad-spectrum antibiotics. Moreover, 31 studies examined clinical outcomes such as length of hospitalization, ICU admission, hospital readmission, multidrug-resistant or opportunistic infection, or mortality, and 27 (87%) found that allergy-labeled patients had at least 1 negative outcome. Of 9 studies examining healthcare costs, 7 (78%) found that allergy-labeled patients incurred significantly higher drug or hospital-related costs. Conclusions: Antibiotic allergy labels have negative effects on antibiotic use, clinical outcomes, and economic outcomes in a variety of clinical settings and populations.

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Section: Antibiotic Allergy Labels and Clinical Outcomesmentioning

confidence: 99%

“…Turner et al, 2018 40 Patients with a penicillin allergy label were more likely to receive vancomycin (38% vs 11%; P < .01) and were less likely to receive nafcillin (5% vs 45%; P < .01). Allergy-labeled patients were more likely to have an infectious disease consult (74% vs 58%; P = .02).…”

Section: Not Assessedmentioning

confidence: 99%

The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: A systematic review

Krah

Jones

Lake

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…5,6 Although most reactions following use of penicillin and related antibiotics are not true drug allergies, medical practitioners often prescribe less effective or more expensive alternatives. [7][8][9] This leads to an increased risk of adverse events, more drug-resistant organisms and more Clostridium difficile infections. 10,11 Presently, primary care providers struggle to rule out penicillin drug allergies.…”

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confidence: 99%

Amoxicillin oral provocation challenge in a primary care clinic: a descriptive analysis

Gateman

Rumble

Protudjer

et al. 2021

cmajo

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ffecting about 10% of patients, penicillin drug allergy is the most frequently reported drug allergy. 1 Penicillin drug allergy is commonly diagnosed after a childhood rash is assumed to be caused by recent penicillin administration but which is not investigated further. 2 T-lymphocyte-mediated nonimmediate reactions typically present with maculopapular rashes days after ingestion. 3 In contrast, immunoglobulin E (IgE)-mediated immediate reactions occur within the first hour and appear as urticaria, angioedema, rhinitis, bronchospasm or, rarely, as anaphylaxis. 2,4 Despite their clinical use for over 70 years, penicillin and penicillin-related antibiotics continue to be recommended for first-line therapy in numerous respiratory tract, skin, joint and cardiovascular infections. 5,6 Although most reactions following use of penicillin and related antibiotics are not true drug allergies, medical practitioners often prescribe less effective or more expensive alternatives. [7][8][9] This leads to an increased risk of adverse events, more drug-resistant organisms and more Clostridium difficile infections. 10,11 Presently, primary care providers struggle to rule out penicillin drug allergies. 12 A referral to an allergist for all patients with suspected penicillin drug allergy is impractical, as there are millions of patients with presumed penicillin allergy. 13 In Canada, there is less than 1 allergist per 100 000 people. Not surprisingly, this translates to long wait times, with an estimated wait time for penicillin drug allergy consultation of 12-18 months in rural southwestern Ontario (H. K., unpublished observations, 2019).Primary care providers have limited experience and training in performing skin testing for drug allergy or measurement of specific IgE levels. Skin testing can be inconvenient and time Amoxicillin oral provocation challenge in a primary care clinic: a descriptive analysis

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“…Turner et al performed a retrospective cohort assessing the outcomes in patients with and without β-lactam allergies and MSSA BSI and found patients with β-lactam allergies were more likely to receive definitive therapy with vancomycin ( P < .01). 10 The authors also found no difference in 30-day ( P = .99) or 90-day ( P = .47) all-cause mortality between groups, but receipt of a β-lactam was protective toward 30-day (adjOR, 0.26; 95% CI, 0.12-0.54) and 90-day (adjOR, 0.41; 95%CI, 0.21-0.81) mortality, which is similar to the current study. While 44% of β-lactam allergic patients still received a β-lactam, the authors concluded that a reported penicillin allergy only matters if it prevents a patient from receiving a β-lactam.…”

Section: Discussionmentioning

confidence: 99%

“…6 -8 Nonsevere or falsely reported β-lactam allergies represent an important barrier to receiving optimal therapy for MSSA BSI, but data surrounding this influence on patient outcomes are limited. 8 -10…”

Section: Introductionmentioning

confidence: 99%

Impact of Reported β-Lactam Allergy on Management of Methicillin-Sensitive Staphylococcus aureus Bloodstream Infections

Veve

January

Kenney

et al. 2019

Journal of Pharmacy Practice

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Background: Antistaphylococcal β-lactams antibiotics are the preferred treatment for methicillin-sensitive Staphylococcus aureus (MSSA) infections. Patient-reported β-lactam allergies may complicate antibiotic decision-making and delay optimal therapy, with potential implications on patient outcomes. Objective: To determine the impact of reported β-lactam allergies on the receipt of optimal therapy and outcomes for MSSA bloodstream infections (BSI). Methods: Retrospective, matched cohort of MSSA BSI patients with and without a reported β-lactam allergy. The primary end point was receipt of optimal therapy, defined as an antistaphylococcal β-lactam. Results: Two hundred twelve patients were included: 53 with reported β-lactam allergy and 159 without β-lactam allergy. Commonly reported β-lactam allergies were 26 (49%) immune-mediated reaction and 8 (15%) intolerance, with 19 (36%) having no documented reaction. Optimal antibiotics were given to 135 patients without a β-lactam allergy and 37 patients with a reported β-lactam allergy (85% vs 70%, P = .015). Among reported β-lactam allergy patients, those without a documented reaction were less likely to receive optimal therapy (47% vs 79 %, P = .042). Reported β-lactam allergy was not associated with clinical response ( P = .61) or MSSA-related mortality ( P = .83). When adjusting for immunosuppression, variables independently associated with optimal therapy were β-lactam allergy (adjusted odds ratio [adjOR], 0.3; 95% confidence interval [CI], 0.1-0.6) and infectious diseases consultation (adjOR, 6.1; 95%CI, 2.7-13.9). Optimal antibiotic use was associated with decreased all-cause 90-day mortality (adjOR, 0.23; 95%CI, 0.09-0.54). Conclusions: Patients with reported β-lactam allergies, particularly those without a documented reaction, were less likely to receive optimal antibiotics for MSSA BSI. Patient outcomes may be improved with enhanced quality of allergy history and routine infectious disease consultation.

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Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia

Cited by 19 publications

References 33 publications

The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: A systematic review

The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: A systematic review

Amoxicillin oral provocation challenge in a primary care clinic: a descriptive analysis

Impact of Reported β-Lactam Allergy on Management of Methicillin-Sensitive Staphylococcus aureus Bloodstream Infections

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