Department of Clinical Immunology, Princess Margaret Hospital, Perth, WA, Australia; Faculty of Health and Medical Sciences, UWA Medical School, University of Western Australia, Perth, WA, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia; PathWest Laboratory Medicine, Perth, WA, Australia; Department of Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Department of Clinical Immunology, Princess Margaret Hospital, Perth, WA, Australia.
J Allergy Clin Immunol Pract. 2019 Mar;7(3):975-982. doi: 10.1016/j.jaip.2018.09.003. Epub 2018 Sep 19.
Self-reported antibiotic allergies are common among hospitalized adults and children. However, there is a paucity of studies investigating the impact of an antibiotic allergy label in childhood.
To investigate the impact of antibiotic allergy labeling on clinical outcomes in children.
A retrospective study was conducted in a major pediatric tertiary hospital to capture inpatient admissions (N = 1672) in April 2014 and April 2015. Data, collected by chart review, included documented antibiotic allergy labels, antibiotic prescriptions, admitting specialty, hospital length of stay, and hospital readmissions.
Of the 1672 pediatric patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients; most were β-lactam allergy labels (85%), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P < .001); no sex effect was seen. Patients with antibiotic allergy labels received more macrolide (P = .045), quinolones (P = .01), lincosamide (P < .001), and metronidazole (P = .009) antibiotics than did patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis, and admitting specialty, children with any antibiotic or β-lactam allergy label had longer hospital stays (odds ratio, 1.62; 95% CI, 1.05-2.50; P = .03) with a mean length of hospital stay of 3.8 days for those without a label and 5.2 days for those with a β-lactam allergy label.
This is the first study demonstrating the negative impact of antibiotic allergy labels on clinical outcomes in children, as evidenced by significant alternate antibiotic use and longer hospital stays.
在住院的成年人和儿童中，自我报告的抗生素过敏很常见。然而，目前研究抗生素过敏标签对儿童的影响的研究很少。
研究抗生素过敏标签对儿童临床结局的影响。
在一家主要的儿科三级医院进行了一项回顾性研究，以捕获 2014 年 4 月和 2015 年 4 月的住院患者（N=1672）。通过病历回顾收集的数据包括记录的抗生素过敏标签、抗生素处方、入院科室、住院时间和医院再入院。
在调查的 1672 名儿科患者中，58.1%为男性，44.8%接受了抗生素治疗。在 5.3%的患者中记录了抗生素过敏标签；大多数是β-内酰胺类过敏标签（85%），主要是对未指定的青霉素过敏。抗生素过敏标签的发生率随年龄增加而增加，具有统计学意义（P<.001）；未观察到性别差异。有抗生素过敏标签的患者比没有抗生素过敏标签的患者接受了更多的大环内酯类（P=.045）、喹诺酮类（P=.01）、林可酰胺类（P<.001）和甲硝唑（P=.009）抗生素。在校正患者年龄、性别、主要诊断和入院科室后，有任何抗生素或β-内酰胺类抗生素过敏标签的儿童住院时间更长（优势比，1.62；95%CI，1.05-2.50；P=.03），无标签的儿童平均住院时间为 3.8 天，有β-内酰胺类过敏标签的儿童为 5.2 天。
这是第一项研究表明抗生素过敏标签对儿童临床结局的负面影响，这表现在抗生素替代使用和住院时间延长方面。
