Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada; Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada; Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
J Allergy Clin Immunol Pract. 2013 May-Jun;1(3):252-7. doi: 10.1016/j.jaip.2013.01.006. Epub 2013 Feb 14.
Prescribing antibiotics to patients with a history of penicillin allergy is common in clinical practice. Opting for non-beta-lactam antibiotics has its inconveniences and is often unnecessary, because most of these patients are in fact not allergic.
This study aimed to determine how physicians in a large Canadian tertiary-care academic hospital without allergists on staff treat patients with a history of penicillin allergy.
A retrospective study was conducted during a 1-year period among all patients hospitalized in the intensive care unit, coronary care unit, and internal medicine wards. Files of patients with a record of penicillin allergy were reviewed to assess the need for antibiotics during their hospitalization and the decision-making process underlying the choice of antibiotic. The additional costs of alternative antibiotics were calculated.
The files of 1738 patients admitted over a 1-year period were hand reviewed. A history of penicillin allergy was found in 172 patients (9.9%). The allergic reaction was described in only 30% of cases and left unmentioned in 20.7%. Beta-lactam antibiotics were used on 56 occasions despite a history of penicillin allergy. The use of alternative antibiotics in place of the beta-lactam standard of care carried an additional cost of $15,672 Canadian.
Alleged penicillin allergy is common among hospitalized patients and leads to substantial additional costs. Poor documentation of penicillin allergy likely reflects a lack of knowledge on this issue in the medical community, which impairs optimal treatment of these patients. Increased education on this matter is needed, and allergists on staff could be part of the solution.
在临床实践中，给有青霉素过敏史的患者开抗生素是很常见的。选择非β-内酰胺类抗生素有其不便之处，而且往往是不必要的，因为这些患者中的大多数实际上并没有过敏。
本研究旨在确定在没有过敏专科医生的加拿大大型三级保健学术医院中，医生如何治疗有青霉素过敏史的患者。
在 1 年期间，对所有入住重症监护病房、冠心病监护病房和内科病房的患者进行了回顾性研究。回顾有青霉素过敏记录的患者的病历，以评估他们在住院期间使用抗生素的必要性以及选择抗生素的决策过程。计算替代抗生素的额外成本。
在 1 年期间，共手检了 1738 名住院患者的病历。发现 172 名患者（9.9%）有青霉素过敏史。只有 30%的病例描述了过敏反应，20.7%的病例未提及。尽管有青霉素过敏史，但仍有 56 次使用了β-内酰胺类抗生素。替代β-内酰胺类标准治疗抗生素的使用会增加 15672 加元的额外成本。
住院患者中常出现所谓的青霉素过敏，导致大量额外费用。青霉素过敏记录不佳可能反映了医学界对此问题缺乏了解，这会影响这些患者的最佳治疗。需要对此问题进行更多教育，并且在医院配备过敏专科医生可能是解决方案的一部分。
