Savannah M van Dijk1, Helga Gardarsdottir2, Marjan W M Wassenberg3, Jan Jelrik Oosterheert4, Mark C H de Groot5, Heike Rockmann6. 1. Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands. 2. Division of Laboratory and Pharmacy, Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands. 3. Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands. 4. Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands. 5. Division of Laboratory and Pharmacy, Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands. 6. Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: h.rockmann@umcutrecht.nl.
Abstract
BACKGROUND: Suspected penicillin allergy (Pen-A) is often not verified or excluded by diagnostic testing. OBJECTIVE: To assess the prevalence and impact of Pen-A registration in a Dutch University Medical Center. METHODS: In a prospective matched cohort study, all admitted patients (July 2013-July 2014) who underwent a pharmacotherapeutic interview were selected. Patients with a registered Pen-A were matched on age, sex, and department of admission with up to 3 patients without a registered Pen-A. Relative risks (RRs) of receiving a reserve antibiotic, death during hospitalization, and rehospitalization were compared in the 2 cohorts. The number and type of antibiotics prescribed during admission and duration of hospitalization were compared. RESULTS: Of 17,959 patients, 1010 (5.6%) patients (66.7% women; median age, 55 years) had a Pen-A registration. These patients had a higher risk of receiving reserve antibiotics (RR, 1.38; 95% CI, 1.22-1.56) and of being rehospitalized within 12 weeks (RR, 1.28; 95% CI, 1.10-1.49). A significantly larger proportion of Pen-A registered patients received reserve antibiotics such as tetracyclines (1.8% vs 0.8%), macrolides/lincosamides/streptogramins (12.5% vs 4.9%), and quinolones (7.9% vs 4.3%) or received 2 or more types of antibiotics during hospitalization (21.7% vs 16.9%). CONCLUSIONS: Prevalence of Pen-A registration in hospitalized patients is high, has high impact on antibiotic prescribing, and is associated with a higher risk of readmission. Verification of the Pen-A in hospitalized patients might restrict the use of reserve antibiotics and improve patient outcome.
BACKGROUND: Suspected penicillinallergy (Pen-A) is often not verified or excluded by diagnostic testing. OBJECTIVE: To assess the prevalence and impact of Pen-A registration in a Dutch University Medical Center. METHODS: In a prospective matched cohort study, all admitted patients (July 2013-July 2014) who underwent a pharmacotherapeutic interview were selected. Patients with a registered Pen-A were matched on age, sex, and department of admission with up to 3 patients without a registered Pen-A. Relative risks (RRs) of receiving a reserve antibiotic, death during hospitalization, and rehospitalization were compared in the 2 cohorts. The number and type of antibiotics prescribed during admission and duration of hospitalization were compared. RESULTS: Of 17,959 patients, 1010 (5.6%) patients (66.7% women; median age, 55 years) had a Pen-A registration. These patients had a higher risk of receiving reserve antibiotics (RR, 1.38; 95% CI, 1.22-1.56) and of being rehospitalized within 12 weeks (RR, 1.28; 95% CI, 1.10-1.49). A significantly larger proportion of Pen-A registered patients received reserve antibiotics such as tetracyclines (1.8% vs 0.8%), macrolides/lincosamides/streptogramins (12.5% vs 4.9%), and quinolones (7.9% vs 4.3%) or received 2 or more types of antibiotics during hospitalization (21.7% vs 16.9%). CONCLUSIONS: Prevalence of Pen-A registration in hospitalized patients is high, has high impact on antibiotic prescribing, and is associated with a higher risk of readmission. Verification of the Pen-A in hospitalized patients might restrict the use of reserve antibiotics and improve patient outcome.
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