Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study
Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study
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DOI：
10.1136/bmj.k2400
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发表时间：
2018-06-27
影响因子：
105.7
通讯作者：
Choi, Hyon K.
中科院分区：
文献类型：
--
作者：
Blumenthal, Kimberly G.;Lu, Na;Choi, Hyon K.
目的：评价青霉素过敏与耐甲氧西林金黄色葡萄球菌(MRSA)和艰难梭菌发生的关系。设计基于人群的配对队列研究。设置-英国全科医学(1995年-2015年)。参与者-301399名没有耐甲氧西林金黄色葡萄球菌和艰难梭菌的成年人在健康改善网络数据库中登记：141名青霉素过敏患者和237258名在年龄、性别和研究进入时间上匹配的对照。主要观察指标-主要结果是发生MRSA和艰难梭菌的风险。结果：组成人青霉素过敏患者141例，发生耐甲氧西林金黄色葡萄球菌1365例(其中青霉素过敏患者442例，对照病例923例)，艰难梭菌1688例(青霉素过敏患者442例，对照病例1246例)。在青霉素过敏患者中，MRSA的调整风险比为1.69(95%可信区间为1.51-1.90)，艰难梭菌的调整风险比为1.26(1.12-1.40)。在青霉素过敏患者中，抗生素使用的调整发生率比为：大环内酯类4.15(95%可信区间4.12~4.17)，克林霉素3.89(3.66~4.12)，氟喹诺酮类2.10(2.08~2.13)。耐甲氧西林金黄色葡萄球菌(MRSA)和艰难梭菌增加的风险中，增加使用β-内酰胺类抗生素的比例分别为55%和35%。结论记录在案的青霉素过敏与MRSA和艰难梭菌的风险增加有关，这是通过增加使用β-内酰胺类替代抗生素所介导的。系统地解决青霉素过敏可能是一项重要的公共卫生战略，以减少带有青霉素过敏标签的患者中MRSA和艰难梭菌的发生率。
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 beta lactam antibiotics and beta 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 beta 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 beta 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.