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Penicillin allergy label increased hospital stays, antibiotic resistant infections
The label of a penicillin allergy may have adverse implications for the quantity and quality of health care for patients in hospitalized settings, according to data.
“It is important to know if you are allergic to penicillin,” Eric Macy, MD, of the Southern California Permanente Medical Group, department of allergy, at San Diego Medical Center, said in a press release. “This medical history detail impacts not only critical health care decisions, but it greatly impacts cost.”
Researchers conducted a retrospective, matched cohort study of 51,582 (99.6% of all possible cases) hospitalized patients with a penicillin allergy to two unique discharge diagnosis category-matched, sex-matched, age-matched, and date of admission-matched control each. Patients with penicillin allergy averaged 0.59 (9.9%; 95% CI, 0.47-0.71) more total hospital days during 20.1 months of follow-up compared with controls.
Researchers wrote that patients with the penicillin allergy were treated with more fluoroquinolones, clindamycin, and vancomycin (P<.0001) for each antibiotic compared with controls. Those with the allergy also demonstrated 23.4% (95% CI, 15.6-31.7) more Clostridium difficile, 14.1% (95% CI, 7.1-21.6) more methicillin-resistant Staphylococcus aureus (MRSA) and 30.1% (95% CI, 12.5-50.4) more vancomycin-resistant Enterococcus (VRE) infections than expected compared with controls.
“In the hospital setting we found this translates to about 10% more hospital days and significantly more Clostridium difficile, [MRSA], and [VRE] infections,” Macy said in the release. “These adverse events occur because penicillin ‘allergic’ patients are given more broad spectrum antibiotics, including ciprofloxacin, vancomycin, clindamycin, and third or greater generation cephalosporins. Previous work by our group has shown that less than 5% of individuals who carry a history of penicillin ‘allergy’ are truly allergic.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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The data by Macy and colleagues were novel; this has been suspected for a number of years because it’s known that patients who have a history of penicillin allergy are administered antibiotics like quinolones, vancomycin and third-generation cephalosporins disproportionately more compared to patients without a history of penicillin allergy.
On the other hand, it’s also known that prescribing those antibiotics (especially quinolones and vancomycin) is a risk factor for development of Clostridium difficile and VRE.
Although it’s not that surprising that there is a strong association between a penicillin allergy and these outcomes, it has never been formally shown in a study like this.
This study places the spotlight on something that’s been under the radar for a long time. One way to cut down on these complications is to identify patients mislabeled as being pencillin allergic by performing penicillin skin testing.
Overall, it’s an important study and hopefully others will be able to reproduce it in the future.