Austin Health, Melbourne, VIC
Austin Health, Melbourne, VIC.
Med J Aust. 2016 Apr 18;204(7):273. doi: 10.5694/mja15.01329.
To determine the nature, prevalence and description accuracy of recorded antibiotic allergy labels (AALs) in a cohort of general medical inpatients, and to assess the feasibility of an oral antibiotic re-challenge study.
Multicentre cross-sectional study.
All patients admitted to the general medical units of Austin Health and Alfred Health, 18 May - 5 June 2015.
Baseline demographics, medical and allergy history, infection diagnoses and antibiotic prescribing data for general medical inpatients were collected. A questionnaire was administered to clarify AAL history, followed by correlation of responses with electronic and admissions record descriptions. A hypothetical oral re-challenge in a supervised setting was offered to patients with low risk allergy phenotypes (non-immediate reaction, non-severe cutaneous adverse reaction, or unknown reaction more than 10 years ago).
Of the 453 inpatients, 107 (24%) had an AAL (median age, 82 years; interquartile range, 74-87 years); 160 individual AALs were recorded, and there was a mismatch in AAL description between recording platforms in 25% of cases. Most patients with an AAL were women (64%; P < 0.001), and more presented with concurrent immunosuppression than those without an AAL (23% v 8%; P < 0.001). β-Lactam penicillins were employed less frequently in patients with an AAL (16% v 35%; P = 0.02), while ceftriaxone (32% v 20%; P = 0.02) and fluoroquinolones (6% v 2%; P = 0.04) were used more often. Fifty-four per cent of patients with AALs were willing to undergo oral re-challenge, of whom 48% had a low risk allergy phenotype.
AAL prevalence in general medical inpatients was 24%, and was associated with excessive use of broad spectrum antibiotics. Allergies in a large proportion of patients with AALs were incorrectly documented, and were non-immune-mediated and potentially amenable to oral re-challenge. A direct oral re-challenge study in carefully selected patients with low risk allergy phenotypes appears feasible.
确定一般内科住院患者队列中记录的抗生素过敏标签（AAL）的性质、流行程度和描述准确性，并评估口服抗生素再挑战研究的可行性。
多中心横断面研究。
2015 年 5 月 18 日至 6 月 5 日期间，在奥斯汀健康和阿尔弗雷德健康的一般医疗单位入院的所有患者。
收集了一般内科住院患者的基线人口统计学、医疗和过敏史、感染诊断和抗生素处方数据。对患者进行了一项问卷调查以澄清 AAL 病史，然后将回答与电子病历和入院记录描述进行了相关性分析。对低风险过敏表型（非即刻反应、非严重皮肤不良反应，或 10 年前未知反应）的患者提供了在监督环境下进行口服再挑战的假设。
在 453 名住院患者中，有 107 名（24%）有 AAL（中位数年龄，82 岁；四分位间距，74-87 岁）；记录了 160 个单独的 AAL，在 25%的情况下，记录平台之间的 AAL 描述存在不匹配。有 AAL 的患者中大多数为女性（64%；P < 0.001），并且与无 AAL 的患者相比，有更多的同时存在免疫抑制的患者（23%比 8%；P < 0.001）。有 AAL 的患者β-内酰胺类青霉素的使用率较低（16%比 35%；P = 0.02），而头孢曲松（32%比 20%；P = 0.02）和氟喹诺酮类（6%比 2%；P = 0.04）的使用率更高。54%的有 AAL 的患者愿意进行口服再挑战，其中 48%的患者具有低风险过敏表型。
一般内科住院患者 AAL 的患病率为 24%，与过度使用广谱抗生素有关。很大一部分有 AAL 的患者的过敏反应记录不正确，并且是非免疫介导的，可能适合口服再挑战。在仔细选择的低风险过敏表型患者中进行直接口服再挑战研究似乎是可行的。
