This article is more than 5 years old. Information may no longer be current.
Patients with UTI, penicillin allergy at increased risk for ciprofloxacin resistance
Click Here to Manage Email Alerts
Patients with a UTI and a documented penicillin-class allergy may be at a slightly increased risk for ciprofloxacin resistance, according to study results published in Infection Control & Hospital Epidemiology.
“Though up to 90% of [patients with a documented penicillin allergy] may safely tolerate penicillin, the presence of an allergy label is associated with increased use of broad-spectrum antimicrobials including fluoroquinolones, glycopeptides and carbapenems,” researchers wrote. “In the treatment of UTIs, recent fluoroquinolone use is a demonstrated risk factor for ciprofloxacin resistance among Escherichia coli UTIs.”
For their study, the researchers studied adult hospitalized patients to determine the relationship between a documented penicillin-class allergy and ciprofloxacin-resistant community-onset UTIs. They included 6,361 patients admitted to an inpatient unit in a 1,300-bed teaching hospital between Nov. 1, 2011, and June 30, 2016, with a UTI diagnosis and positive urine culture in the first 48 hours. There were 6,361 patients admitted to the hospital with community-onset UTI, including 19.7% with a penicillin-class allergy documented in their electronic records.
The researchers analyzed 7,431 isolates representing 75 organisms. Escherichia coli (n = 2,797), Enterococcus faecalis (n = 1,281), Klebsiella pneumoniae (n = 876), Pseudomonas aeruginosa (n = 391) and Enterococcus faecium (n = 292) were the most prevalent organisms and comprised 75.9% of all isolates.
A ciprofloxacin-resistant UTI was 1.13 times more likely to have occurred in patients with a penicillin-class allergy label (56.5%) compared with patients without a penicillin-class allergy label (50.9%).
The researchers determined that 24% of the total effect of a penicillin-class allergy label on ciprofloxacin-resistant UTI was tied to fluoroquinolone use in the past 90 days.
“Among patients presenting with a UTI, those with a penicillin-class allergy label may be at a slightly increased risk of not being covered by ciprofloxacin,” the researchers wrote. “Recent fluoroquinolone use partially contributes to this effect, suggesting additional mechanisms behind this association.”
The researchers noted that they were limited to measuring antibiotic exposure within their health care system.
“Our finding that nearly 20% of patients in this cohort had a documented penicillin-class allergy highlights the potential for more accurate classification and labeling of allergies to support antimicrobial stewardship,” the researchers wrote. “We show that a penicillin-class allergy is a modest risk factor for ciprofloxacin resistance, which may be due in part to increased use of fluoroquinolones. This finding suggests that one possible solution to fluoroquinolone overuse would be to reassess the veracity of penicillin allergy labels at the point of care.” – by Bruce Thiel
Disclosure: The researchers report support from NIH grants during the study.
Click Here to Manage Email Alerts