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J Allergy Clin Immunol. 2014 Mar;133(3):790-6. doi: 10.1016/j.jaci.2013.09.021. Epub 2013 Nov 1.

Health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: A cohort study.

Author information

1
Southern California Permanente Medical Group, Department of Allergy, San Diego Medical Center, San Diego, Calif. Electronic address: eric.m.macy@kp.org.
2
Kaiser Permanente Health Care Program, Department of Research and Evaluation, Pasadena, Calif.

Abstract

BACKGROUND:

Penicillin is the most common drug "allergy" noted at hospital admission, although it is often inaccurate.

OBJECTIVE:

We sought to determine total hospital days, antibiotic exposures, and the prevalence rates of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) in patients with and without penicillin "allergy" at hospital admission.

METHODS:

We performed a retrospective, matched cohort study of subjects admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012.

RESULTS:

It was possible to match 51,582 (99.6% of all possible cases) unique hospitalized subjects with penicillin "allergy" to 2 unique discharge diagnosis category-matched, sex-matched, age-matched, and date of admission-matched control subjects each. Cases with penicillin "allergy" averaged 0.59 (9.9%; 95% CI, 0.47-0.71) more total hospital days during 20.1 ± 10.5 months of follow-up compared with control subjects. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin (P < .0001) for each antibiotic compared with control subjects. Cases had 23.4% (95% CI, 15.6% to 31.7%) more C difficile, 14.1% (95% CI, 7.1% to 21.6%) more MRSA, and 30.1% (95% CI, 12.5% to 50.4%) more VRE infections than expected compared with control subjects.

CONCLUSIONS:

A penicillin "allergy" history, although often inaccurate, is not a benign finding at hospital admission. Subjects with a penicillin "allergy" history spend significantly more time in the hospital. Subjects with a penicillin "allergy" history are exposed to significantly more antibiotics previously associated with C difficile and VRE. Drug "allergies" in general, but most those notably to penicillin, are associated with increased hospital use and increased C difficile, MRSA, and VRE prevalence.

KEYWORDS:

Adverse drug reaction; Clostridium difficile; antibiotics; electronic medical record; hospital use; methicillin-resistant Staphylococcus aureus; multiple drug intolerance syndrome; penicillin allergy; prevalence; vancomycin-resistant Enterococcus species

Comment in

PMID:
24188976
DOI:
10.1016/j.jaci.2013.09.021
[Indexed for MEDLINE]

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