The Impact of Reporting a Prior Penicillin Allergy on the Treatment of Methicillin-Sensitive Staphylococcus aureus Bacteremia.
The Impact of Reporting a Prior Penicillin Allergy on the Treatment of Methicillin-Sensitive Staphylococcus aureus Bacteremia.
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DOI：
10.1371/journal.pone.0159406
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Walensky RP
中科院分区：
文献类型：
--
作者：
Blumenthal KG;Shenoy ES;Huang M;Kuhlen JL;Ware WA;Parker RA;Walensky RP
甲氧西林敏感金黄色葡萄球菌 (MSSA) 菌血症是一种病态感染，接受肠外 β-内酰胺治疗可降低死亡率。很大一部分 MSSA 菌血症患者报告有青霉素过敏，但很少有真正的过敏。确定 MSSA 菌血症患者最佳和充分治疗的频率和预测因素。回顾性队列。 2009 年 1 月至 2013 年 10 月患有 MSSA 菌血症的成人住院患者。主要措施是最佳治疗 (OT) 试验，定义为住院时间≥3 天或出院后使用任何一线药物（萘夫西林、苯唑西林、头孢唑啉或青霉素 G，如果敏感）。次要指标是完成充分治疗 (AT)，定义为住院时间≥10 天或出院后使用适合 MSSA 菌血症的药物。数据以电子方式收集，关键变量通过图表审查手动验证。对数二项式回归模型用于确定结果的频率和预测因子。在 456 名患者中，346 名 (76%) 接受了 OT 试验。与没有青霉素过敏的患者相比，报告青霉素过敏的患者 (13%) 接受 OT 试验的可能性较小（47% vs. 80%，p <0.001）。调整其他因素后，青霉素过敏是 OT 试验的最大阴性预测因子（RR 0.64 [0.49, 0.83]）。传染病 (ID) 咨询是所有患者 OT 试验的最大阳性预测因素 (RR 1.34 [1.14, 1.57])。在报告青霉素过敏的患者中，过敏/免疫学咨询是 OT 试验的最重要的单一预测因素 (RR 2.33 [1.44, 3.77])。在 440 名患者中，391 名 (89%) 完成了 AT，ID 咨询是结果的最大阳性预测因子 (RR 1.28 [1.15, 1.43])。近 25% 的 MSSA 菌血症患者未接受 OT 试验，约 10% 未接受 AT 完成。据报告青霉素过敏减少，ID咨询增加，OT的可能性增加。过敏评估结合 ID 咨询可能会改善 MSSA 菌血症患者的预后。
Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is a morbid infection with mortality benefit from receipt of parenteral β-lactam therapy. A substantial portion of MSSA bacteremia patients report penicillin allergy, but infrequently have true allergy. To determine the frequency and predictors of optimal and adequate therapy in patients with MSSA bacteremia. Retrospective cohort. Adult inpatients with MSSA bacteremia, January 2009 through October 2013. The primary measure was a trial of optimal therapy (OT), defined as ≥3 inpatient days or discharge on any first-line agents (nafcillin, oxacillin, cefazolin, or penicillin G, if susceptible). The secondary measure was completion of adequate therapy (AT), defined as ≥10 inpatient days or discharge on an agent appropriate for MSSA bacteremia. Data were electronically gathered with key variables manually validated through chart review. Log-binomial regression models were used to determine the frequency and predictors of outcomes. Of 456 patients, 346 (76%) received a trial of OT. Patients reporting penicillin allergy (13%) were less likely to receive OT trial than those without penicillin allergy (47% vs. 80%, p <0.001). Adjusting for other factors, penicillin allergy was the largest negative predictor of OT trial (RR 0.64 [0.49, 0.83]). Infectious Disease (ID) consultation was the largest positive predictor of OT trial across all patients (RR 1.34 [1.14, 1.57]). Allergy/Immunology consultation was the single most important predictor of OT trial among patients reporting penicillin allergy (RR 2.33 [1.44, 3.77]). Of 440 patients, 391 (89%) completed AT, with ID consultation the largest positive predictor of the outcome (RR 1.28 [1.15, 1.43]). Nearly 25% of patients with MSSA bacteremia did not receive OT trial and about 10% did not receive AT completion. Reported penicillin allergy reduced, and ID consult increased, the likelihood of OT. Allergy evaluation, coupled with ID consultation, may improve outcomes in MSSA bacteremic patients.