Pharmacy Department, Royal Cornwall Hospital Trust, Truro, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK.
Global Digital Health Unit, School of Public Health, Imperial College, London, UK.
J Hosp Infect. 2020 Sep;106(1):35-42. doi: 10.1016/j.jhin.2020.05.042. Epub 2020 Jun 3.
Patients with a penicillin allergy record are usually prescribed non-penicillin antibiotics and have worse health outcomes. This study explored the impact of penicillin allergy records on antibiotic treatment costs and patient length of stay.
Patients prescribed a systemic antibacterial agent between April 2016 and March 2018 in a 750-bed English hospital were included in this study. The following data were extracted for each patient: age, sex, comorbidities, infection treated, antibiotic usage (defined daily dose), hospital length of stay and penicillin allergy status. Multi-variable log-linear modelling was used to determine associations between patients labelled as penicillin allergic and total antibiotic costs and length of stay. Using the above models, the potential reductions in total cost and hospital bed-days of 'delabelling' patients with a penicillin allergy record were estimated.
Penicillin allergy records were present in 14.3% of hospital admissions and were associated with an increase in non-penicillin antibiotic prescribing, a 28.4% increase in antibiotic costs and 5.5% longer length of hospital stay compared with patients without a penicillin allergy record. Patients with a penicillin allergy record accounted for an excess antibiotic spend of £10,637 (2.61% of annual antibiotic drug spend) and 3522 excess bed-days (3.87% of annual bed-days). Delabelling 50% of patients with a self-reported penicillin allergy record would save an estimated £5501 in antibiotic costs and £503,932 through reduced excess bed-days.
Delabelling patients with a self-reported allergy record has potential to reduce antibiotic costs, but its biggest cost impact is via a reduction in excess bed-days.
有青霉素过敏记录的患者通常会被开处非青霉素类抗生素，其健康状况也会更差。本研究旨在探讨青霉素过敏记录对抗生素治疗费用和患者住院时间的影响。
本研究纳入了 2016 年 4 月至 2018 年 3 月期间在一家拥有 750 张床位的英国医院接受全身抗菌药物治疗的患者。从每位患者中提取以下数据：年龄、性别、合并症、治疗感染、抗生素使用（定义日剂量）、住院时间和青霉素过敏状况。多变量对数线性模型用于确定被标记为青霉素过敏的患者与总抗生素费用和住院时间之间的关联。利用上述模型，估计了“去标签”有青霉素过敏记录的患者的总费用和住院床日的潜在减少量。
14.3%的住院患者有青霉素过敏记录，与未记录青霉素过敏的患者相比，他们更有可能使用非青霉素类抗生素，抗生素费用增加 28.4%，住院时间延长 5.5%。有青霉素过敏记录的患者抗生素支出额外增加了 10637 英镑（占年度抗生素药物支出的 2.61%），住院床日额外增加了 3522 天（占年度住院床日的 3.87%）。去标签 50%的自我报告有青霉素过敏记录的患者，预计可节省抗生素费用 5501 英镑，减少额外住院床日 503932 天。
去标签自我报告过敏记录的患者有可能降低抗生素费用，但最大的成本影响是通过减少额外住院床日来实现的。
