Hannah Imlay1,2, Elizabeth M Krantz2, Erica J Stohs3, Kristine F Lan1, Jacqlynn Zier2, H Nina Kim1, Robert M Rakita1, Ajit P Limaye1, Anna Wald1,2,4,5, Steven A Pergam1,2, Catherine Liu1,2. 1. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA. 2. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. 3. Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Seattle, Washington, USA, and Omaha, Nebraska, USA. 4. Department of Epidemiology, University of Washington, Seattle, Washington, USA. 5. Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: Patients with reported β-lactam antibiotic allergies (BLAs) are more likely to receive broad-spectrum antibiotics and experience adverse outcomes. Data describing antibiotic allergies among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients are limited. METHODS: We reviewed records of adult SOT or allogeneic HCT recipients from 1 January 2013 to 31 December 2017 to characterize reported antibiotic allergies at time of transplantation. Inpatient antibiotic use was examined for 100 days posttransplant. Incidence rate ratios (IRRs) comparing antibiotic use in BLA and non-BLA groups were calculated using multivariable negative binomial models for 2 metrics: days of therapy (DOT) per 1000 inpatient days and percentage of antibiotic exposure-days. RESULTS: Among 2153 SOT (65%) and HCT (35%) recipients, 634 (29%) reported any antibiotic allergy and 347 (16%) reported BLAs. Inpatient antibiotics were administered to 2020 (94%) patients during the first 100 days posttransplantation; average antibiotic exposure was 41% of inpatient-days (interquartile range, 16.7%-62.5%). BLA patients had significantly higher DOT for vancomycin (IRR, 1.4 [95% confidence interval {CI}, 1.2-1.7]; P < .001), clindamycin (IRR, 7.6 [95% CI, 2.2-32.4]; P = .001), and aztreonam in HCT (IRR, 9.7 [95% CI, 3.3-35.0]; P < .001), and fluoroquinolones in SOT (IRR, 2.9 [95% CI, 2.1-4.0]; P < .001); these findings were consistent when using percentage of antibiotic exposure-days. CONCLUSIONS: Transplant recipients are frequently exposed to antibiotics and have a high prevalence of reported antibiotic allergies. Reported BLA was associated with greater use of β-lactam antibiotic alternatives. Pretransplant antibiotic allergy evaluation may optimize antibiotic use in this population.
BACKGROUND: Patients with reported β-lactam antibiotic allergies (BLAs) are more likely to receive broad-spectrum antibiotics and experience adverse outcomes. Data describing antibiotic allergies among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients are limited. METHODS: We reviewed records of adult SOT or allogeneic HCT recipients from 1 January 2013 to 31 December 2017 to characterize reported antibiotic allergies at time of transplantation. Inpatient antibiotic use was examined for 100 days posttransplant. Incidence rate ratios (IRRs) comparing antibiotic use in BLA and non-BLA groups were calculated using multivariable negative binomial models for 2 metrics: days of therapy (DOT) per 1000 inpatient days and percentage of antibiotic exposure-days. RESULTS: Among 2153 SOT (65%) and HCT (35%) recipients, 634 (29%) reported any antibiotic allergy and 347 (16%) reported BLAs. Inpatient antibiotics were administered to 2020 (94%) patients during the first 100 days posttransplantation; average antibiotic exposure was 41% of inpatient-days (interquartile range, 16.7%-62.5%). BLA patients had significantly higher DOT for vancomycin (IRR, 1.4 [95% confidence interval {CI}, 1.2-1.7]; P < .001), clindamycin (IRR, 7.6 [95% CI, 2.2-32.4]; P = .001), and aztreonam in HCT (IRR, 9.7 [95% CI, 3.3-35.0]; P < .001), and fluoroquinolones in SOT (IRR, 2.9 [95% CI, 2.1-4.0]; P < .001); these findings were consistent when using percentage of antibiotic exposure-days. CONCLUSIONS: Transplant recipients are frequently exposed to antibiotics and have a high prevalence of reported antibiotic allergies. Reported BLA was associated with greater use of β-lactam antibiotic alternatives. Pretransplant antibiotic allergy evaluation may optimize antibiotic use in this population.
Authors: Jennifer S McDanel; Eli N Perencevich; Daniel J Diekema; Loreen A Herwaldt; Tara C Smith; Elizabeth A Chrischilles; Jeffrey D Dawson; Lan Jiang; Michihiko Goto; Marin L Schweizer Journal: Clin Infect Dis Date: 2015-04-21 Impact factor: 9.079
Authors: Rebekah W Moehring; Deverick J Anderson; Ronda L Cochran; Lauri A Hicks; Arjun Srinivasan; Elizabeth S Dodds Ashley Journal: Clin Infect Dis Date: 2016-12-07 Impact factor: 9.079
Authors: Erin L Conway; Ken Lin; John A Sellick; Kari Kurtzhalts; James Carbo; Michael C Ott; Kari A Mergenhagen Journal: Clin Ther Date: 2017-10-09 Impact factor: 3.393
Authors: David Vyles; Asriani Chiu; John Routes; Mariana Castells; Elizabeth J Phillips; Jennifer Kibicho; David C Brousseau Journal: Pediatrics Date: 2018-05 Impact factor: 7.124
Authors: Helen L Zhang; Judith A Anesi; Keith W Hamilton; Leigh Cressman; Warren B Bilker; Ebbing Lautenbach Journal: Open Forum Infect Dis Date: 2022-07-29 Impact factor: 4.423