Desai Shilpa H, Kaplan Michael S, Chen Qiaoling, Macy Eric M
Fellow-In-Training in the Allergy Department of the Los Angeles Medical Center in CA.
Allergist at the Los Angeles Medical Center in CA.
Perm J. 2017;21:16-080. doi: 10.7812/TPP/16-080. Epub 2017 Jan 6.
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.
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.
Retrospective. All pregnant women who delivered live infants in Kaiser Permanente Southern California between January 1, 2009, and December 31, 2014, were identified.
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.
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.
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.
在有或无B族链球菌（GBS）感染的孕妇中，与未经证实的青霉素过敏潜在相关的发病率尚不清楚。青霉素过敏试验在孕期是安全的，但很少进行。
确定在一大群有或无未经证实的青霉素过敏史、有或无GBS的孕妇中，与抗生素使用相关的发病率。
回顾性研究。确定了2009年1月1日至2014年12月31日期间在南加州凯撒医疗集团分娩活婴的所有孕妇。
分娩时的青霉素过敏状态、分娩方式、母婴住院情况、围产期抗生素暴露、新的抗生素相关药物不良反应以及新的艰难梭菌感染。
在研究期间，共有170379名独特的女性怀孕201316次。分娩时有活跃但未经证实的青霉素过敏的女性有16084次怀孕。GBS阳性女性有42524次怀孕，其中3500人也有青霉素过敏。有或无GBS的青霉素过敏女性剖宫产率显著更高（约10%），产后住院天数显著更多（约0.1天）。在GBS阳性女性中，有未经证实的青霉素过敏的女性接触头孢唑林、克林霉素、万古霉素和庆大霉素的剂量显著更多，且与所有抗生素使用相关的药物不良反应发生率显著更高。
未经证实的青霉素过敏与更多的住院情况和额外的发病率相关。对有青霉素过敏史的孕妇进行青霉素过敏试验可能有助于减少这些不良后果。
