Veterans Affairs Western New York Healthcare System, Buffalo, New York.
Veterans Affairs Western New York Healthcare System, Buffalo, New York; Division of Infectious Diseases, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
Clin Ther. 2017 Nov;39(11):2276-2283. doi: 10.1016/j.clinthera.2017.09.012. Epub 2017 Oct 9.
The objective of this study was to evaluate the impact of a listed penicillin allergy on the time to first dose of antibiotic in a Veterans Affairs hospital. Additional clinical outcomes of patients with penicillin allergies were compared with those of patients without a penicillin allergy.
A retrospective chart review of veterans admitted through the emergency department with a diagnosis of pneumonia, urinary tract infection, bacteremia, and sepsis from January 2006 to December 2015 was conducted. The primary outcome was time to first dose of antibiotic treatment, defined as the time from when the patient presented to the emergency department to the medication administration time. Secondary outcomes included total antibiotic therapy duration and treatment outcomes, including mortality, length of stay, and 30-day readmission rate.
A total of 403 patients were included in the final analysis; 57 patients (14.1%) had a listed penicillin allergy. The average age of the population was 75 years and 99% of the population was male. The mean time to first dose of antibiotic treatment for patients with a penicillin allergy was prolonged compared with those without a penicillin allergy (236.1 vs 186.6 minutes; P = 0.03), resulting in an approximately 50-minute delay. Penicillin-allergic patients were more likely to receive a carbapenem or fluoroquinolone antibiotic (P < 0.0001).
Patients with a penicillin allergy had a prolonged time to first dose of antibiotic therapy. No significant differences were found in total antibiotic duration, length of stay, or 30-day readmission rate. The small sample size, older population, and single-center nature of this study may limit the generalizability of the present findings to other populations.
本研究旨在评估退伍军人事务部医院中青霉素过敏列表对首次给予抗生素时间的影响。将比较有青霉素过敏的患者与无青霉素过敏的患者的其他临床结果。
对 2006 年 1 月至 2015 年 12 月期间因肺炎、尿路感染、菌血症和败血症通过急诊部门入院的退伍军人进行了回顾性图表审查。主要结果是首次给予抗生素治疗的时间，定义为患者从急诊就诊到给药的时间。次要结果包括总抗生素治疗持续时间和治疗结果，包括死亡率、住院时间和 30 天再入院率。
最终有 403 名患者纳入了最终分析；57 名患者（14.1%）有青霉素过敏史。人群的平均年龄为 75 岁，99%为男性。有青霉素过敏的患者首次给予抗生素治疗的平均时间明显长于无青霉素过敏的患者（236.1 分钟 vs. 186.6 分钟；P = 0.03），导致大约 50 分钟的延迟。青霉素过敏患者更有可能接受碳青霉烯类或氟喹诺酮类抗生素（P < 0.0001）。
有青霉素过敏的患者首次给予抗生素治疗的时间延长。总抗生素持续时间、住院时间或 30 天再入院率无显著差异。本研究的样本量小、人群年龄较大以及单中心性质可能限制了本研究结果在其他人群中的推广。
