Sousa-Pinto Bernardo, Araújo Luís, Freitas Alberto, Delgado Luís
Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.
MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
Int Arch Allergy Immunol. 2018;176(3-4):234-238. doi: 10.1159/000488857. Epub 2018 May 22.
Beta-lactam allergy is overdiagnosed. Diagnosis of penicillin allergy has been associated with a greater use of hospital resources and an increased risk of antibiotic-resistant infections, although this issue remains poorly studied in children. We aimed to compare patient characteristics and use of hospital resources in hospitalized children with and without a record of penicillin allergy.
We identified all hospitalizations in children labelled as being allergic to penicillin in a database containing all hospitalizations in Portuguese public hospitals between 2000 and 2014, and compared these with a similar number of age-, sex-, and main diagnosis-matched hospitalizations without a penicillin allergy label. Comparisons were made for length of hospital stay, comorbidities (Charlson Comorbidity Index), in-hospital mortality, and hospitalization costs.
We identified 1,718 hospitalizations corresponding to children labelled as penicillin-allergic. Compared with patients without such a label, these children had longer hospital stays (mean 5 vs. 4 days, p = 0.03) and a higher comorbidity index (mean 0.11 vs. 0.09, p < 0.001). Hospitalization costs were also higher (EUR 2,071 vs. 1,798), but the difference was not significant (p = 0.12).
Hospitalizations of children labelled as allergic to penicillin are associated with longer hospital stays, more comorbidities, and a tendency towards higher hospitalization costs. An accurate diagnosis of penicillin allergy based on clinical history and confirmatory tests is therefore essential in all paediatric patients.
β-内酰胺类药物过敏存在过度诊断的情况。青霉素过敏的诊断与更多地使用医院资源以及抗生素耐药性感染风险增加有关，尽管这一问题在儿童中仍研究不足。我们旨在比较有和没有青霉素过敏记录的住院儿童的患者特征及医院资源使用情况。
我们在一个包含2000年至2014年葡萄牙公立医院所有住院病例的数据库中，识别出所有标记为对青霉素过敏的儿童住院病例，并将其与数量相似的年龄、性别和主要诊断相匹配但无青霉素过敏标记的住院病例进行比较。比较了住院时间、合并症（查尔森合并症指数）、院内死亡率和住院费用。
我们识别出1718例标记为青霉素过敏的儿童住院病例。与无此标记的患者相比，这些儿童的住院时间更长（平均5天对4天，p = 0.03），合并症指数更高（平均0.11对0.09，p < 0.001）。住院费用也更高（2071欧元对1798欧元），但差异不显著（p = 0.12）。
标记为对青霉素过敏的儿童住院与更长的住院时间、更多的合并症以及住院费用升高的趋势相关。因此，基于临床病史和确诊试验对青霉素过敏进行准确诊断对所有儿科患者至关重要。
