β-内酰胺类抗生素过敏报告对耐甲氧西林敏感血流感染治疗的影响。

Impact of Reported β-Lactam Allergy on Management of Methicillin-Sensitive Bloodstream Infections.

机构信息

2971Henry Ford Hospital, Detroit, MI, USA.

Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.

出版信息

J Pharm Pract. 2020 Dec;33(6):809-814. doi: 10.1177/0897190019841737. Epub 2019 Apr 16.

DOI:10.1177/0897190019841737

PMID:30991876

Abstract

BACKGROUND

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.

OBJECTIVE

To determine the impact of reported β-lactam allergies on the receipt of optimal therapy and outcomes for MSSA bloodstream infections (BSI).

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

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。

目的

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。

方法

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。

结果

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）。