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BMJ. 2018 Jun 27;361:k2400. doi: 10.1136/bmj.k2400.

Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study.

Blumenthal KG1,2,3, Lu N4, Zhang Y4,3, Li Y4,2, Walensky RP2,3,5, Choi HK4,3.

Author information

1
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA 20114, USA kblumenthal1@partners.org.
2
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
3
Harvard Medical School, Boston, MA, USA.
4
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA 20114, USA.
5
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

Abstract

OBJECTIVE:

To evaluate the relation between penicillin allergy and development of meticillin resistant Staphylococcus aureus (MRSA) and C difficile.

DESIGN:

Population based matched cohort study.

SETTING:

United Kingdom general practice (1995-2015).

PARTICIPANTS:

301 399 adults without previous MRSA or C difficile enrolled in the Health Improvement Network database: 64 141 had a penicillin allergy and 237 258 comparators matched on age, sex, and study entry time.

MAIN OUTCOME MEASURES:

The primary outcome was risk of incident MRSA and C difficile. Secondary outcomes were use of β lactam antibiotics and β lactam alternative antibiotics.

RESULTS:

Among 64 141 adults with penicillin allergy and 237 258 matched comparators, 1365 developed MRSA (442 participants with penicillin allergy and 923 comparators) and 1688 developed C difficile (442 participants with penicillin allergy and 1246 comparators) during a mean 6.0 years of follow-up. Among patients with penicillin allergy the adjusted hazard ratio for MRSA was 1.69 (95% confidence interval 1.51 to 1.90) and for C difficile was 1.26 (1.12 to 1.40). The adjusted incidence rate ratios for antibiotic use among patients with penicillin allergy were 4.15 (95% confidence interval 4.12 to 4.17) for macrolides, 3.89 (3.66 to 4.12) for clindamycin, and 2.10 (2.08 to 2.13) for fluoroquinolones. Increased use of β lactam alternative antibiotics accounted for 55% of the increased risk of MRSA and 35% of the increased risk of C difficile.

CONCLUSIONS:

Documented penicillin allergy was associated with an increased risk of MRSA and C difficile that was mediated by the increased use of β lactam alternative antibiotics. Systematically addressing penicillin allergies may be an important public health strategy to reduce the incidence of MRSA and C difficile among patients with a penicillin allergy label.

PMID:
29950489
PMCID:
PMC6019853
DOI:
10.1136/bmj.k2400
[Indexed for MEDLINE]
Free PMC Article

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