Victoria Hall1,2, Micah Wong3, Maitri Munsif4, Brittany R Stevenson5,6, Katie Elliott7, Michaela Lucas5,6, Ashleigh J Baird8, Eugene Athan8,9, Melissa Young10, Robert Pickles11,12, Allen C Cheng2,13, Andrew J Stewardson2,14, Ar K Aung2,4,13, Jason A Trubiano1,15,16. 1. Department of Infectious Diseases and Centre for Antibiotic Allergy and Research, Austin Hospital, VIC, Australia. 2. Department of Infectious Diseases, Alfred Health, VIC, Australia. 3. School of Medicine, University of Melbourne, VIC, Australia. 4. Department of General Medicine, Alfred Hospital, Monash University, VIC, Australia. 5. Department of Immunology, Sir Charles Gairdner Hospital, WA, Australia. 6. PathWest Immunology, Nedlands, WA, Australia. 7. School of Medicine, University of Western Australia, WA, Australia. 8. University Hospital Geelong Barwon Health, Geelong, VIC, Australia. 9. Deakin University, School of Medicine, Geelong, VIC, Australia. 10. Hunter New England Local Health District, John Hunter Hospital, NSW, Australia. 11. Departments of Infectious Diseases and General Medicine, John Hunter Hospital, Hunter New England Local Health District, NSW, Australia. 12. School of Medicine and Public Health, University of Newcastle, NSW, Australia. 13. School of Public Health and Preventive Medicine, Monash University, VIC, Australia. 14. ASID Clinical Research Network, Sydney, NSW, Australia. 15. Department of Medicine, University of Melbourne, VIC, Australia. 16. The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, VIC, Australia.
Abstract
OBJECTIVES: The epidemiology, clinical characteristics and outcomes of antimicrobial-associated anaphylaxis remain ill-defined. We sought to examine antimicrobial anaphylaxis with regard to: (i) the frequency of implicated antimicrobials; (ii) attributable mortality; and (iii) referral for definitive allergy assessment. METHODS: This was conducted through a national retrospective multicentre cohort study at five Australian tertiary hospitals (January 2010 to December 2015). Cases of antimicrobial anaphylaxis were identified from ICD-10 coding and adverse drug reaction committee databases. RESULTS: There were 293 participants meeting the case definition of antimicrobial anaphylaxis and 310 antimicrobial anaphylaxis episodes. Of 336 implicated antimicrobials, aminopenicillins (62/336, 18.5%) and aminocephalosporins (57/336, 17%) were implicated most frequently. ICU admission occurred in 43/310 (13.9%) episodes; however, attributable mortality was low (3/310, 1%). The rate of anaphylaxis to IV antibiotics was 3.5 (95% CI=2.9-4.3) per 100 000 DDDs and the rate of hospital-acquired anaphylaxis was 1.9 (95% CI=2.1-3.3) per 100 000 occupied bed-days. We observed overall low rates of hospital discharge documentation (222/310, 71.6%) and follow-up by specialist allergy services (73/310, 23.5%), which may compromise medication safety and antimicrobial prescribing in future. CONCLUSIONS: This study demonstrated that a high proportion of severe immediate hypersensitivity reactions presenting or acquired in Australian hospitals are secondary to aminopenicillins and aminocephalosporins. Overall rates of hospital-acquired anaphylaxis, predominantly secondary to cephalosporins, are low, and also associated with low inpatient mortality.
OBJECTIVES: The epidemiology, clinical characteristics and outcomes of antimicrobial-associated anaphylaxis remain ill-defined. We sought to examine antimicrobial anaphylaxis with regard to: (i) the frequency of implicated antimicrobials; (ii) attributable mortality; and (iii) referral for definitive allergy assessment. METHODS: This was conducted through a national retrospective multicentre cohort study at five Australian tertiary hospitals (January 2010 to December 2015). Cases of antimicrobial anaphylaxis were identified from ICD-10 coding and adverse drug reaction committee databases. RESULTS: There were 293 participants meeting the case definition of antimicrobial anaphylaxis and 310 antimicrobial anaphylaxis episodes. Of 336 implicated antimicrobials, aminopenicillins (62/336, 18.5%) and aminocephalosporins (57/336, 17%) were implicated most frequently. ICU admission occurred in 43/310 (13.9%) episodes; however, attributable mortality was low (3/310, 1%). The rate of anaphylaxis to IV antibiotics was 3.5 (95% CI=2.9-4.3) per 100 000 DDDs and the rate of hospital-acquired anaphylaxis was 1.9 (95% CI=2.1-3.3) per 100 000 occupied bed-days. We observed overall low rates of hospital discharge documentation (222/310, 71.6%) and follow-up by specialist allergy services (73/310, 23.5%), which may compromise medication safety and antimicrobial prescribing in future. CONCLUSIONS: This study demonstrated that a high proportion of severe immediate hypersensitivity reactions presenting or acquired in Australian hospitals are secondary to aminopenicillins and aminocephalosporins. Overall rates of hospital-acquired anaphylaxis, predominantly secondary to cephalosporins, are low, and also associated with low inpatient mortality.
Authors: Ar Kar Aung; Steven Walker; Yin Li Khu; Mei Jie Tang; Jennifer I Lee; Linda Velta Graudins Journal: Eur J Clin Pharmacol Date: 2022-02-16 Impact factor: 2.953
Authors: Alberto Martelli; Rosario Ippolito; Martina Votto; Maria De Filippo; Ilaria Brambilla; Mauro Calvani; Fabio Cardinale; Elena Chiappini; Marzia Duse; Sara Manti; Gian Luigi Marseglia; Carlo Caffarelli; Claudio Cravidi; Michele Miraglia Del Giudice; Maria Angela Tosca Journal: Acta Biomed Date: 2020-09-15