Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study

Reported allergy to beta-lactam antibiotics is common and often leads to unnecessary avoidance in patients who could tolerate these antibiotics. We prospectively evaluated the impact of these reported allergies on clinical outcomes. We conducted a trainee-led prospective cohort study to determine th...

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Bibliographic Details
Published in:Clinical infectious diseases Vol. 63; no. 7; p. 904
Main Authors: MacFadden, Derek R, LaDelfa, Anthony, Leen, Jessica, Gold, Wayne L, Daneman, Nick, Weber, Elizabeth, Al-Busaidi, Ibrahim, Petrescu, Dan, Saltzman, Ilana, Devlin, Megan, Andany, Nisha, Leis, Jerome A
Format: Journal Article
Language:English
Published: United States 01.10.2016
Subjects:
Adult
Aged
Aged, 80 and over
Antimicrobial Stewardship
beta-Lactams - adverse effects
Drug Hypersensitivity
Female
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Prospective Studies
Treatment Outcome
beta-lactam allergy
penicillin allergy
antimicrobial stewardship
clinical outcome
quality improvement
ISSN:1537-6591, 1537-6591
Online Access:Get more information
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Summary:Reported allergy to beta-lactam antibiotics is common and often leads to unnecessary avoidance in patients who could tolerate these antibiotics. We prospectively evaluated the impact of these reported allergies on clinical outcomes. We conducted a trainee-led prospective cohort study to determine the burden and clinical impact of reported beta-lactam allergy on patients seen by infectious diseases consultation services at 3 academic hospitals. The primary outcome was a composite measure of readmission for the same infection, acute kidney injury, Clostridium difficile infection, or drug-related adverse reactions requiring discontinuation. Predictors of interest were history of beta-lactam allergy and receipt of preferred beta-lactam therapy. Among 507 patients, 95 (19%) reported beta-lactam allergy; preferred therapy was a beta-lactam in 72 (76%). When beta-lactam therapy was preferred, 25 (35%) did not receive preferred therapy due to their report of allergy even though 13 (52%) reported non-severe prior reactions. After adjustment for confounders, patients who did not receive preferred beta-lactam therapy were at greater risk of adverse events (adjusted odds ratio [aOR], 3.1; 95% confidence interval [CI], 1.28-7.89) compared with those without reported allergy. In contrast, patients who received preferred beta-lactam therapy had a similar risk of adverse events compared with patients not reporting allergy (aOR, 1.33; 95% CI, .62-2.87). Avoidance of preferred beta-lactam therapy in patients who report allergy is associated with an increased risk of adverse events. Development of inpatient programs aimed at accurately identifying beta-lactam allergies to safely promote beta-lactam administration among these patients is warranted.
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/ciw462