2971Henry Ford Hospital, Detroit, MI, USA.
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
J Pharm Pract. 2020 Dec;33(6):809-814. doi: 10.1177/0897190019841737. Epub 2019 Apr 16.
Antistaphylococcal β-lactams antibiotics are the preferred treatment for methicillin-sensitive (MSSA) infections. Patient-reported β-lactam allergies may complicate antibiotic decision-making and delay optimal therapy, with potential implications on patient outcomes.
To determine the impact of reported β-lactam allergies on the receipt of optimal therapy and outcomes for MSSA bloodstream infections (BSI).
Retrospective, matched cohort of MSSA BSI patients with and without a reported β-lactam allergy. The primary end point was receipt of optimal therapy, defined as an antistaphylococcal β-lactam.
Two hundred twelve patients were included: 53 with reported β-lactam allergy and 159 without β-lactam allergy. Commonly reported β-lactam allergies were 26 (49%) immune-mediated reaction and 8 (15%) intolerance, with 19 (36%) having no documented reaction. Optimal antibiotics were given to 135 patients without a β-lactam allergy and 37 patients with a reported β-lactam allergy (85% vs 70%, .015). Among reported β-lactam allergy patients, those without a documented reaction were less likely to receive optimal therapy (47% vs 79 .042). Reported β-lactam allergy was not associated with clinical response ( .61) or MSSA-related mortality ( .83). When adjusting for immunosuppression, variables independently associated with optimal therapy were β-lactam allergy (adjusted odds ratio [adjOR], 0.3; 95% confidence interval [CI], 0.1-0.6) and infectious diseases consultation (adjOR, 6.1; 95%CI, 2.7-13.9). Optimal antibiotic use was associated with decreased all-cause 90-day mortality (adjOR, 0.23; 95%CI, 0.09-0.54).
Patients with reported β-lactam allergies, particularly those without a documented reaction, were less likely to receive optimal antibiotics for MSSA BSI. Patient outcomes may be improved with enhanced quality of allergy history and routine infectious disease consultation.
抗葡萄球菌β-内酰胺类抗生素是治疗耐甲氧西林金黄色葡萄球菌（MSSA）感染的首选药物。患者自述的β-内酰胺类过敏可能会使抗生素决策复杂化，并延迟最佳治疗，从而对患者的预后产生潜在影响。
确定报告的β-内酰胺类过敏对 MSSA 血流感染（BSI）患者接受最佳治疗和结局的影响。
回顾性匹配 MSSA BSI 患者的队列，其中包括有报告β-内酰胺类过敏的患者和无β-内酰胺类过敏的患者。主要终点是接受最佳治疗，定义为使用抗葡萄球菌β-内酰胺类药物。
共纳入 212 例患者：53 例报告β-内酰胺类过敏，159 例无β-内酰胺类过敏。常见的报告β-内酰胺类过敏包括 26 例（49%）免疫介导的反应和 8 例（15%）不耐受，其中 19 例（36%）无记录的反应。135 例无β-内酰胺类过敏的患者和 37 例报告β-内酰胺类过敏的患者接受了最佳抗生素治疗（85% vs 70%，.015）。在报告β-内酰胺类过敏的患者中，无记录反应的患者接受最佳治疗的可能性较低（47% vs 79%.042）。报告的β-内酰胺类过敏与临床反应无关（.61）或 MSSA 相关死亡率无关（.83）。当调整免疫抑制状态时，与最佳治疗相关的独立变量包括β-内酰胺类过敏（调整后的优势比[adjOR]，0.3；95%置信区间[CI]，0.1-0.6）和感染病咨询（adjOR，6.1；95%CI，2.7-13.9）。最佳抗生素使用与降低 MSSA BSI 患者 90 天全因死亡率相关（adjOR，0.23；95%CI，0.09-0.54）。
报告有β-内酰胺类过敏的患者，特别是无记录反应的患者，更不可能接受 MSSA BSI 的最佳抗生素治疗。通过提高过敏史的质量和常规感染病咨询，可能改善患者的预后。
