Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: A cohort study

• Published in: Journal of allergy and clinical immunology Vol. 133; no. 3; pp. 790 - 796
• Main Authors: Macy, Eric, Contreras, Richard
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2014; Elsevier; Elsevier Limited
• Subjects: Adult; Adverse drug reaction; Aged; Allergies; Allergy and Immunology; antibiotics; Bacterial Infections - epidemiology; Biological and medical sciences; Clostridium difficile; Cohort Studies; Delivery of Health Care - utilization; Drug Hypersensitivity - complications; electronic medical record; Enterococcus; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Health Care Costs; hospital use; Hospitalization; Hospitals; Humans; Immunopathology; Length of Stay; Male; Medical records; Medical sciences; methicillin-resistant Staphylococcus aureus; Middle Aged; multiple drug intolerance syndrome; Penicillin; penicillin allergy; Penicillins - adverse effects; Prevalence; Retrospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Staphylococcus aureus; vancomycin-resistant Enterococcus species; electronic medical record; MDIS; Clostridium difficile; VRE; methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococcus species; Adverse drug reaction; prevalence; penicillin allergy; ICD-9; MRSA; hospital use; antibiotics; multiple drug intolerance syndrome; International Classification of Diseases, Ninth Revision; Multiple-drug intolerance syndrome; Allergy; Prevalence; Toxicity; Clostridiales; Electronics; Epidemiology; Penicillin derivatives; Association; Immunology; Cohort study; Penicillin; Bacteria; Micrococcales; Micrococcaceae; Medical record; Hospital; Species; Staphylococcus aureus; Enterococcus; Human; Drug; Immunopathology; Multiple; Health; β-Lactams; Use; Hospitalization; Care; Infection; Streptococcaceae; Intolerance; Antibiotic; Clostridiaceae
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2013.09.021

Penicillin is the most common drug “allergy” noted at hospital admission, although it is often inaccurate. We sought to determine total hospital days, antibiotic exposures, and the prevalence rates of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) in patients with and without penicillin “allergy” at hospital admission. We performed a retrospective, matched cohort study of subjects admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012. It was possible to match 51,582 (99.6% of all possible cases) unique hospitalized subjects with penicillin “allergy” to 2 unique discharge diagnosis category–matched, sex-matched, age-matched, and date of admission–matched control subjects each. Cases with penicillin “allergy” averaged 0.59 (9.9%; 95% CI, 0.47-0.71) more total hospital days during 20.1 ± 10.5 months of follow-up compared with control subjects. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin (P < .0001) for each antibiotic compared with control subjects. Cases had 23.4% (95% CI, 15.6% to 31.7%) more C difficile, 14.1% (95% CI, 7.1% to 21.6%) more MRSA, and 30.1% (95% CI, 12.5% to 50.4%) more VRE infections than expected compared with control subjects. A penicillin “allergy” history, although often inaccurate, is not a benign finding at hospital admission. Subjects with a penicillin “allergy” history spend significantly more time in the hospital. Subjects with a penicillin “allergy” history are exposed to significantly more antibiotics previously associated with C difficile and VRE. Drug “allergies” in general, but most those notably to penicillin, are associated with increased hospital use and increased C difficile, MRSA, and VRE prevalence.