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- Title
Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study.
- 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.
- Abstract
Background. 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. Methods. We conducted a trainee-led prospective cohort study to determine the burden and clinical impact of reported beta-lactam allergyon patients seen by infectious diseases consultation services at 3 academic hospitals. The primary outcomewas 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. Results. Among 507 patients, 95 (19%) reported beta-lactam allergy; preferred therapy was a beta-lactam in 72 (76%). When betalactam 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). Conclusions. Avoidance of preferred beta-lactamtherapy 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.
- Subjects
BETA lactamases; CLOSTRIDIOIDES difficile; PHYSIOLOGICAL effects of antibiotics; DRUG side effects; SIDE effects of anti-infective agents; THERAPEUTICS
- Publication
Clinical Infectious Diseases, 2016, Vol 63, Issue 7, p904
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciw462