Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care, Hospital of the University of Pennsylvania, Philadelphia.
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Albert Einstein Medical Center, Philadelphia.
Clin Infect Dis. 2018 Jun 18;67(1):27-33. doi: 10.1093/cid/ciy037.
Patients hospitalized with hematologic malignancy are particularly vulnerable to infection. The impact of reported beta-lactam (BL) allergy in this population remains unknown.
This was a retrospective cohort study of adult inpatients with hematologic malignancy admitted at 2 tertiary care hospitals from 2010 through 2015. The primary outcome was hospital length of stay (LOS) after administration of the first antibiotic. Secondary outcomes included readmission, mortality, complications, hospital charges, and antibiotic usage. Our goal was to define the impact of BL-only allergy (BLOA) label on clinical outcomes compared to those with no BL allergy (NBLA) in hematologic malignancy inpatients who required systemic antibiotics.
In our cohort (n = 4671), 38.3% had leukemia, 4.9% had Hodgkin lymphoma, 36.1% had non-Hodgkin lymphoma, and 20.7% had multiple myeloma. Among patients, 35.1% reported antibiotic allergy, and 14.1% (n = 660) had BLOA (including 9.3% with penicillin-only allergy and 3.3% cephalosporin-only allergy). Patients with BLOA had longer median LOS compared to patients with NBLA (11.3 vs 7.6 days, P < .001), which remained significant after multivariable adjustment. Patients with BLOA also had significantly worse outcomes in terms of mortality rate at 30 days (7.6% vs 5.3%, P = .017) and 180 days (15.8% vs 12.2%, P = .013), 30-day readmission rate, Clostridium difficile rate, hospital charges ($223 046 vs $173 256, P < .001), antibiotic classes used, and antibiotic duration.
In hospitalized patients with hematologic malignancy, patients with reported BL allergy had worse clinical outcomes and higher healthcare cost than those without BL allergy label.
患有血液恶性肿瘤的住院患者特别容易感染。该人群中报告的β-内酰胺（BL）过敏的影响尚不清楚。
这是一项回顾性队列研究，纳入了 2010 年至 2015 年期间在 2 家三级保健医院住院的血液恶性肿瘤成年患者。主要结局是使用首剂抗生素后患者的住院时间（LOS）。次要结局包括再入院、死亡率、并发症、住院费用和抗生素使用情况。我们的目标是确定与血液恶性肿瘤住院患者中无 BL 过敏（NBLA）标签的患者相比，BL 过敏（BLOA）标签对临床结局的影响，这些患者需要全身使用抗生素。
在我们的队列（n=4671）中，38.3%患有白血病，4.9%患有霍奇金淋巴瘤，36.1%患有非霍奇金淋巴瘤，20.7%患有多发性骨髓瘤。在患者中，35.1%报告有抗生素过敏，14.1%（n=660）有 BLOA（包括 9.3%青霉素过敏和 3.3%头孢菌素过敏）。与 NBLA 患者相比，BLOA 患者的 LOS 中位数更长（11.3 天比 7.6 天，P<0.001），在多变量调整后仍然显著。BLOA 患者的死亡率（30 天：7.6%比 5.3%，P=0.017；180 天：15.8%比 12.2%，P=0.013）、30 天再入院率、艰难梭菌感染率、住院费用（$223046 比 $173256，P<0.001）、抗生素类别使用和抗生素持续时间也显著更差。
在患有血液恶性肿瘤的住院患者中，与无 BL 过敏标签的患者相比，报告有 BL 过敏的患者临床结局更差，医疗费用更高。
