The Impact of Reported Beta-Lactam Allergy in Hospitalized Patients with Hematologic Malignancies Requiring Antibiotics
Patients hospitalized with hematologic malignancy are particularly vulnerable to infection. The impact of reported beta-lactam (BL) allergy in this population remains unknown. To define the impact of reported BL-only allergy (BLOA) label on clinical outcomes compared to those with no BL allergy (NBL...
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| Veröffentlicht in: | Clinical infectious diseases Jg. 67; H. 1; S. 27 |
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| Abstract | Patients hospitalized with hematologic malignancy are particularly vulnerable to infection. The impact of reported beta-lactam (BL) allergy in this population remains unknown.
To define the impact of reported BL-only allergy (BLOA) label on clinical outcomes compared to those with no BL allergy (NBLA) in hematologic malignancy inpatients requiring systemic antibiotics.
Retrospective cohort study of adult inpatients with hematologic malignancy admitted at two tertiary care hospitals 2010-2015. The primary outcome was hospital length of stay (LOS) after first antibiotic. Secondary outcomes included re-admission, mortality, complications, total hospital charges, and antibiotic usage.
In our cohort (n=4671), 38.3% had leukemia, 4.9% had Hodgkin's lymphoma, 36.1% had non-Hodgkin's lymphoma and 20.7% had multiple myeloma. Among subjects, 35.1% reported antibiotic allergy, 14.1% (n=660) had BLOA (including 9.3% with penicillin-only allergy and 3.3% cephalosporin-only allergy). Subjects with BLOA had longer median LOS compared to NBLA (11.3 vs. 7.6 days, p<0.001), which remained significant after multivariable adjustment. Patients with BLOA also had significantly worse outcomes compared to NBLA in terms of mortality rate at 30-days (7.6% vs. 15.8%, p=0.017) and 180-days (15.8% compared to 12.2%, p=0.013), 30-day re-admission rate (19.2% vs. 15.1%, p=0.008), Clostridium difficile rate (17.7% vs. 11.6%, p<0.001), total hospital charges ($223046 vs. $173256, p<0.001), antibiotic classes used (median 3 vs. 2 classes/patient, p<0.001), and antibiotic duration (median 9.0 vs. 6.0 days, p<0.001).
In hospitalized patients with hematologic malignancy requiring antibiotics, patients with reported BL allergy have worse clinical outcomes and higher healthcare cost than those without BL allergy label. |
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| AbstractList | Patients hospitalized with hematologic malignancy are particularly vulnerable to infection. The impact of reported beta-lactam (BL) allergy in this population remains unknown.
To define the impact of reported BL-only allergy (BLOA) label on clinical outcomes compared to those with no BL allergy (NBLA) in hematologic malignancy inpatients requiring systemic antibiotics.
Retrospective cohort study of adult inpatients with hematologic malignancy admitted at two tertiary care hospitals 2010-2015. The primary outcome was hospital length of stay (LOS) after first antibiotic. Secondary outcomes included re-admission, mortality, complications, total hospital charges, and antibiotic usage.
In our cohort (n=4671), 38.3% had leukemia, 4.9% had Hodgkin's lymphoma, 36.1% had non-Hodgkin's lymphoma and 20.7% had multiple myeloma. Among subjects, 35.1% reported antibiotic allergy, 14.1% (n=660) had BLOA (including 9.3% with penicillin-only allergy and 3.3% cephalosporin-only allergy). Subjects with BLOA had longer median LOS compared to NBLA (11.3 vs. 7.6 days, p<0.001), which remained significant after multivariable adjustment. Patients with BLOA also had significantly worse outcomes compared to NBLA in terms of mortality rate at 30-days (7.6% vs. 15.8%, p=0.017) and 180-days (15.8% compared to 12.2%, p=0.013), 30-day re-admission rate (19.2% vs. 15.1%, p=0.008), Clostridium difficile rate (17.7% vs. 11.6%, p<0.001), total hospital charges ($223046 vs. $173256, p<0.001), antibiotic classes used (median 3 vs. 2 classes/patient, p<0.001), and antibiotic duration (median 9.0 vs. 6.0 days, p<0.001).
In hospitalized patients with hematologic malignancy requiring antibiotics, patients with reported BL allergy have worse clinical outcomes and higher healthcare cost than those without BL allergy label. Patients hospitalized with hematologic malignancy are particularly vulnerable to infection. The impact of reported beta-lactam (BL) allergy in this population remains unknown.BackgroundPatients hospitalized with hematologic malignancy are particularly vulnerable to infection. The impact of reported beta-lactam (BL) allergy in this population remains unknown.This was a retrospective cohort study of adult inpatients with hematologic malignancy admitted at 2 tertiary care hospitals from 2010 through 2015. The primary outcome was hospital length of stay (LOS) after administration of the first antibiotic. Secondary outcomes included readmission, mortality, complications, hospital charges, and antibiotic usage. Our goal was to define the impact of BL-only allergy (BLOA) label on clinical outcomes compared to those with no BL allergy (NBLA) in hematologic malignancy inpatients who required systemic antibiotics.MethodsThis was a retrospective cohort study of adult inpatients with hematologic malignancy admitted at 2 tertiary care hospitals from 2010 through 2015. The primary outcome was hospital length of stay (LOS) after administration of the first antibiotic. Secondary outcomes included readmission, mortality, complications, hospital charges, and antibiotic usage. Our goal was to define the impact of BL-only allergy (BLOA) label on clinical outcomes compared to those with no BL allergy (NBLA) in hematologic malignancy inpatients who required systemic antibiotics.In our cohort (n = 4671), 38.3% had leukemia, 4.9% had Hodgkin lymphoma, 36.1% had non-Hodgkin lymphoma, and 20.7% had multiple myeloma. Among patients, 35.1% reported antibiotic allergy, and 14.1% (n = 660) had BLOA (including 9.3% with penicillin-only allergy and 3.3% cephalosporin-only allergy). Patients with BLOA had longer median LOS compared to patients with NBLA (11.3 vs 7.6 days, P < .001), which remained significant after multivariable adjustment. Patients with BLOA also had significantly worse outcomes in terms of mortality rate at 30 days (7.6% vs 5.3%, P = .017) and 180 days (15.8% vs 12.2%, P = .013), 30-day readmission rate, Clostridium difficile rate, hospital charges ($223 046 vs $173 256, P < .001), antibiotic classes used, and antibiotic duration.ResultsIn our cohort (n = 4671), 38.3% had leukemia, 4.9% had Hodgkin lymphoma, 36.1% had non-Hodgkin lymphoma, and 20.7% had multiple myeloma. Among patients, 35.1% reported antibiotic allergy, and 14.1% (n = 660) had BLOA (including 9.3% with penicillin-only allergy and 3.3% cephalosporin-only allergy). Patients with BLOA had longer median LOS compared to patients with NBLA (11.3 vs 7.6 days, P < .001), which remained significant after multivariable adjustment. Patients with BLOA also had significantly worse outcomes in terms of mortality rate at 30 days (7.6% vs 5.3%, P = .017) and 180 days (15.8% vs 12.2%, P = .013), 30-day readmission rate, Clostridium difficile rate, hospital charges ($223 046 vs $173 256, P < .001), antibiotic classes used, and antibiotic duration.In hospitalized patients with hematologic malignancy, patients with reported BL allergy had worse clinical outcomes and higher healthcare cost than those without BL allergy label.ConclusionsIn hospitalized patients with hematologic malignancy, patients with reported BL allergy had worse clinical outcomes and higher healthcare cost than those without BL allergy label. |
| Author | Hamilton, Keith Huang, Kuan-Hsiang Gary Cluzet, Valerie Fadugba, Olajumoke |
| Author_xml | – sequence: 1 givenname: Kuan-Hsiang Gary surname: Huang fullname: Huang, Kuan-Hsiang Gary organization: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Albert Einstein Medical Center – sequence: 2 givenname: Valerie surname: Cluzet fullname: Cluzet, Valerie organization: Division of Infectious Diseases, Hospital of the University of Pennsylvania – sequence: 3 givenname: Keith surname: Hamilton fullname: Hamilton, Keith organization: Division of Infectious Diseases, Hospital of the University of Pennsylvania – sequence: 4 givenname: Olajumoke surname: Fadugba fullname: Fadugba, Olajumoke organization: Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care, Hospital of the University of Pennsylvania |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29346543$$D View this record in MEDLINE/PubMed |
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| Title | The Impact of Reported Beta-Lactam Allergy in Hospitalized Patients with Hematologic Malignancies Requiring Antibiotics |
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