Shilpa H Desai1, Michael S Kaplan2, Qiaoling Chen3, Eric M Macy4. 1. Fellow-In-Training in the Allergy Department of the Los Angeles Medical Center in CA. shilpa.desai@kp.org. 2. Allergist at the Los Angeles Medical Center in CA. michael.s.kaplan@kp.org. 3. Research Analyst in the Department of Research and Evaluation for Kaiser Foundation Health Plan in Pasadena, CA. qiaoling.chen@kp.org. 4. Allergy Specialist and Researcher in the Department of Allergy at the San Diego Medical Center. He is a Partner Physician with the Southern California Permanente Medical Group, and an Assistant Clinical Professor of Medicine at the University of California, San Diego. eric.m.macy@kp.org.
Abstract
CONTEXT: The morbidity potentially associated with unverified penicillin allergy in pregnant women, with and without group B streptococcus (GBS) infections, is unknown. Penicillin allergy testing is safe during pregnancy but is done infrequently. OBJECTIVE: To determine morbidity associated with antibiotic use in a large cohort of pregnant women, with and without an unverified history of penicillin allergy, and with and without GBS. DESIGN: Retrospective. All pregnant women who delivered live infants in Kaiser Permanente Southern California between January 1, 2009, and December 31, 2014, were identified. MAIN OUTCOME MEASURES: Penicillin allergy status at delivery, delivery method, maternal and infant hospital utilization, peripartum antibiotic exposures, new antibiotic-associated adverse drug reactions, and new Clostridium difficile infections. RESULTS: There were 170,379 unique women who had 201,316 pregnancies during the study period. There were 16,084 pregnancies in women with an active, but unverified, penicillin allergy at delivery. There were 42,524 pregnancies in GBS-positive women, and 3500 also had a penicillin allergy. Women with a penicillin allergy, with or without GBS, had significantly (about 10%) higher cesarean section rates and spent significantly more (about 0.1) days in the hospital after delivery. Among GBS-positive women, those with an unverified penicillin allergy were exposed to significantly more cefazolin, clindamycin, vancomycin, and gentamicin and had significantly higher rates of adverse drug reactions associated with all antibiotic use. CONCLUSIONS: Unverified penicillin allergy is associated with more hospital utilization and additional morbidity. Penicillin allergy testing of pregnant women with a history of penicillin allergy may help reduce these unwanted outcomes.
CONTEXT: The morbidity potentially associated with unverified penicillinallergy in pregnant women, with and without group B streptococcus (GBS) infections, is unknown. Penicillinallergy testing is safe during pregnancy but is done infrequently. OBJECTIVE: To determine morbidity associated with antibiotic use in a large cohort of pregnant women, with and without an unverified history of penicillinallergy, and with and without GBS. DESIGN: Retrospective. All pregnant women who delivered live infants in Kaiser Permanente Southern California between January 1, 2009, and December 31, 2014, were identified. MAIN OUTCOME MEASURES: Penicillinallergy status at delivery, delivery method, maternal and infant hospital utilization, peripartum antibiotic exposures, new antibiotic-associated adverse drug reactions, and new Clostridium difficile infections. RESULTS: There were 170,379 unique women who had 201,316 pregnancies during the study period. There were 16,084 pregnancies in women with an active, but unverified, penicillinallergy at delivery. There were 42,524 pregnancies in GBS-positive women, and 3500 also had a penicillinallergy. Women with a penicillinallergy, with or without GBS, had significantly (about 10%) higher cesarean section rates and spent significantly more (about 0.1) days in the hospital after delivery. Among GBS-positive women, those with an unverified penicillinallergy were exposed to significantly more cefazolin, clindamycin, vancomycin, and gentamicin and had significantly higher rates of adverse drug reactions associated with all antibiotic use. CONCLUSIONS: Unverified penicillinallergy is associated with more hospital utilization and additional morbidity. Penicillinallergy testing of pregnant women with a history of penicillinallergy may help reduce these unwanted outcomes.
Authors: Rodney K Edwards; Ying Tang; Greta B Raglan; Jeff M Szychowski; Jay Schulkin; Stephanie J Schrag Journal: Am J Obstet Gynecol Date: 2015-03-26 Impact factor: 8.661
Authors: Corinna Koebnick; Annette M Langer-Gould; Michael K Gould; Chun R Chao; Rajan L Iyer; Ning Smith; Wansu Chen; Steven J Jacobsen Journal: Perm J Date: 2012
Authors: Cassandra R Duffy; Yongmei Huang; Maria Andrikopoulou; Conrad N Stern-Ascher; Jason D Wright; Mary E D'Alton; Alexander M Friedman Journal: J Matern Fetal Neonatal Med Date: 2020-03-11
Authors: Anna R Wolfson; Christian M Mancini; Aleena Banerji; Xiaoqing Fu; Allison S Bryant; Neelam A Phadke; Erica S Shenoy; Weaam Arman; Yuqing Zhang; Kimberly G Blumenthal Journal: J Allergy Clin Immunol Pract Date: 2020-11-16