Validation of the revised National Institute of Allergy and Infectious Disease / Food Allergy and Anaphylaxis Network diagnostic criteria in emergency department patients

Abstract

Febrile neutropenia leads to over 100,000 hospitalizations in the US each year and can cause sepsis, septic shock, and death. Although first-line treatment for neutropenic fever is an anti-Pseudomonal betalactam, >10%of patients report a beta-lactam allergy. Since 90% of patients with a documented beta-lactam allergy do not have true allergy, we assessed the association of documented beta-lactam allergy to first-line febrile neutropenia antibiotic treatment. METHODS: In this national cross-sectional study of hospitalized patients, we determined the relation of documented beta-lactam allergy (i.e. a penicillin and/or cephalosporin allergy in the electronic medical record) to first-line febrile neutropenia treatment (i.e., cefepime, anti-Pseudomonal carbapenem, or piperacillin-tazobactam), using Generalized Estimating Equations models with logit link adjusted for age, sex, race, intensive care unit location, and resistant organism colonization/infection. RESULTS: Of 290 inpatients with febrile neutropenia receiving antibiotics at 64 US hospitals, 55 (19%) patients had a documented beta-lactam allergy. Patients with a documented beta-lactam allergy less frequently received first-line treatment (36% vs 63%), with less frequent cefepime (36% vs 63%) and piperacillin-tazobactam (9% vs 15%) but more frequent meropenem (35% vs 11%). In the fully adjusted model, patients with a documented beta-lactam allergy had reduced use of first-line febrile neutropenia treatment (adjusted Odds Ratio [aOR] 0.36, 95%CI [0.20, 0.64]). CONCLUSIONS: In this national sample of patients with febrile neutropenia, a documented beta-lactam allergy was associated with a significant, 64%, decreased use of first-line antibiotic treatment. Improved systems for optimizing first-line beta-lactam use in patients with febrile neutropenia are needed to improve care in this high-risk patient population.

Comparison of recent anaphylaxis diagnostic criteria in real life: Can more patients be diagnosed as having anaphylaxis?

“…In another study, of which we could only access the abstract, the sensitivity, specificity, negative predictive value, and positive predictive value of the diagnostic tools were compared and reached quite similar results between the 2 tools. 37 However, we need more data to make a thorough comparison between this study and ours.…”