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J Allergy Clin Immunol Pract. 2016 Sep-Oct;4(5):926-31. doi: 10.1016/j.jaip.2016.03.009. Epub 2016 Apr 28.

The High Impact of Penicillin Allergy Registration in Hospitalized Patients.

Author information

1
Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands.
2
Division of Laboratory and Pharmacy, Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands.
3
Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
4
Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands.
5
Division of Laboratory and Pharmacy, Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
6
Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: h.rockmann@umcutrecht.nl.

Abstract

BACKGROUND:

Suspected penicillin allergy (Pen-A) is often not verified or excluded by diagnostic testing.

OBJECTIVE:

To assess the prevalence and impact of Pen-A registration in a Dutch University Medical Center.

METHODS:

In a prospective matched cohort study, all admitted patients (July 2013-July 2014) who underwent a pharmacotherapeutic interview were selected. Patients with a registered Pen-A were matched on age, sex, and department of admission with up to 3 patients without a registered Pen-A. Relative risks (RRs) of receiving a reserve antibiotic, death during hospitalization, and rehospitalization were compared in the 2 cohorts. The number and type of antibiotics prescribed during admission and duration of hospitalization were compared.

RESULTS:

Of 17,959 patients, 1010 (5.6%) patients (66.7% women; median age, 55 years) had a Pen-A registration. These patients had a higher risk of receiving reserve antibiotics (RR, 1.38; 95% CI, 1.22-1.56) and of being rehospitalized within 12 weeks (RR, 1.28; 95% CI, 1.10-1.49). A significantly larger proportion of Pen-A registered patients received reserve antibiotics such as tetracyclines (1.8% vs 0.8%), macrolides/lincosamides/streptogramins (12.5% vs 4.9%), and quinolones (7.9% vs 4.3%) or received 2 or more types of antibiotics during hospitalization (21.7% vs 16.9%).

CONCLUSIONS:

Prevalence of Pen-A registration in hospitalized patients is high, has high impact on antibiotic prescribing, and is associated with a higher risk of readmission. Verification of the Pen-A in hospitalized patients might restrict the use of reserve antibiotics and improve patient outcome.

KEYWORDS:

Allergy registration; Antimicrobial stewardship; Beta-lactam antibiotic; Drug hypersensitivity; Penicillin

PMID:
27131826
DOI:
10.1016/j.jaip.2016.03.009
[Indexed for MEDLINE]
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