Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study
Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study
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DOI：
10.1093/cid/ciw462
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发表时间：
2016-10-01
影响因子：
11.8
通讯作者：
Leis, Jerome A.
中科院分区：
文献类型：
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作者：
MacFadden, Derek R.;LaDelfa, Anthony;Leis, Jerome A.
由于报告了β -内酰胺过敏而未接受首选β -内酰胺治疗的患者与没有报告β -内酰胺过敏史的患者相比，不良事件的数量增加。方法：我们进行了一项以实习生为主导的前瞻性队列研究，以确定在3所学术医院的感染性疾病咨询服务中报告的β -内酰胺过敏患者的负担和临床影响。主要终点是同一感染、急性肾损伤、艰难梭菌感染或需要停药的药物相关不良反应的再入院综合指标。结果：在507例患者中，95例（19%）报告了β -内酰胺过敏；72例（76%）首选β -内酰胺治疗。当首选β -内酰胺治疗时，25名（35%）患者由于过敏报告而未接受首选治疗，尽管13名（52%）患者报告了非严重的既往反应。调整混杂因素后，未接受首选β -内酰胺治疗的患者与未报告过敏的患者相比，不良事件的风险更高（调整优势比[aOR]， 3.1； 95%可信区间[CI]， 1.28-7.89）。相比之下，接受首选β -内酰胺治疗的患者与未报告过敏的患者相比，不良事件的风险相似（aOR, 1.33; 95% CI, 0.62 -2.87）。报告过敏的患者避免首选β -内酰胺治疗与不良事件风险增加相关。开发旨在准确识别β -内酰胺过敏的住院项目，以安全地促进这些患者的β -内酰胺给药是必要的。
Patients who did not receive preferred beta-lactam therapy due to reported beta-lactam allergy had an increased number of adverse events compared with patients without reported history of beta-lactam allergy.Methods.aEuro integral We conducted a trainee-led prospective cohort study to determine the burden and clinical impact of reported beta-lactam allergy on patients seen by infectious diseases consultation services at 3 academic hospitals. The primary outcome was a composite measure of readmission for the same infection, acute kidney injury, Clostridium difficile infection, or drug-related adverse reactions requiring discontinuation. Predictors of interest were history of beta-lactam allergy and receipt of preferred beta-lactam therapy.Results.aEuro integral Among 507 patients, 95 (19%) reported beta-lactam allergy; preferred therapy was a beta-lactam in 72 (76%). When beta-lactam therapy was preferred, 25 (35%) did not receive preferred therapy due to their report of allergy even though 13 (52%) reported non-severe prior reactions. After adjustment for confounders, patients who did not receive preferred beta-lactam therapy were at greater risk of adverse events (adjusted odds ratio [aOR], 3.1; 95% confidence interval [CI], 1.28-7.89) compared with those without reported allergy. In contrast, patients who received preferred beta-lactam therapy had a similar risk of adverse events compared with patients not reporting allergy (aOR, 1.33; 95% CI, .62-2.87).Conclusions.aEuro integral Avoidance of preferred beta-lactam therapy in patients who report allergy is associated with an increased risk of adverse events. Development of inpatient programs aimed at accurately identifying beta-lactam allergies to safely promote beta-lactam administration among these patients is warranted.