Neu Daniel W, Guidry Tommie Jo, Gillion Amanda R, Pattanaik Debendra N
Pharmacy Department (119), Veterans Affairs Medical Center, Memphis, TN 38104, USA.
College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Mil Med. 2022 May 3;187(5-6):e567-e571. doi: 10.1093/milmed/usab004.
Beta-lactam antibiotics are among the most common and widely used antibiotics. However, reported allergy to this class of antibiotics is also common, leading to the use of alternative broad-spectrum antibiotics by healthcare providers. This has led to the emergence of various negative health outcomes. The purpose of the study is to investigate the impact of using alternative antibiotics secondary to a beta-lactam allergy among U.S. veterans who have otherwise multiple comorbidities.
This retrospective observational analysis was conducted over a 5-year period (January 1, 2011 to December 31, 2016) at the Memphis Veterans Affairs Medical Center (VAMC). Admitted patients with a documented beta-lactam allergy were categorized to preferred or non-preferred status based on initial antibiotic therapy antibiotic, allergy history, published guidelines, and local antibiogram. Preferred therapy was defined as the optimal antibiotic treatment for a given indication based on patient allergy history, published Infectious Disease Society of America guidelines, and local antibiogram of Memphis VAMC. The therapy was classified as "non-preferred" if it did not satisfy the preferred therapy criteria. Non-preferred treatments were further assessed for appropriateness based on indication and patient-specific factors. Chi-square and Fisher's exact tests were conducted to find a difference in rates of negative sequelae among patients receiving preferred vs. non-preferred treatments and appropriate vs. inappropriate treatments.
Of the 1806 admissions identified, data were collected on 95 unique patients with 147 different antibiotic regimens. There were 68 (52%) preferred treatment regimens and 64 (48%) non-preferred treatment regimens. Of the 64 non-preferred treatments, 43 (67%) were inappropriate. There was a statistically significant decrease in the number of adverse drug events and in the combined negative sequelae outcome among patients receiving preferred therapy vs. non-preferred therapy (2 vs. 12; P < .01 and 11 vs. 23; P < .01, respectively).
The receipt of non-preferred antibiotic therapy among veterans with a recorded beta-lactam allergy may be associated with an increased risk of developing negative outcomes. Among military personnel, removing unnecessary beta-lactam allergies would improve readiness with optimal antibiotic choices and avoidance of unnecessary risks, expediting return to full duty.
β-内酰胺类抗生素是最常见且使用最广泛的抗生素之一。然而，报告对此类抗生素过敏的情况也很常见，这导致医疗服务提供者使用替代的广谱抗生素。这已引发各种负面健康后果。本研究的目的是调查在美国患有多种合并症的退伍军人中，因β-内酰胺类过敏而使用替代抗生素的影响。
这项回顾性观察分析在孟菲斯退伍军人事务医疗中心（VAMC）进行，为期5年（2011年1月1日至2016年12月31日）。有记录的β-内酰胺类过敏的入院患者根据初始抗生素治疗、过敏史、已发表的指南和当地抗菌谱被分类为首选或非首选状态。首选治疗被定义为根据患者过敏史、美国传染病学会已发表的指南以及孟菲斯VAMC的当地抗菌谱，针对特定适应症的最佳抗生素治疗。如果治疗不符合首选治疗标准，则分类为“非首选”。根据适应症和患者特定因素进一步评估非首选治疗的适当性。进行卡方检验和费舍尔精确检验，以找出接受首选与非首选治疗以及适当与不适当治疗的患者中负面后遗症发生率的差异。
在确定的1806例入院病例中，收集了95例独特患者的147种不同抗生素治疗方案的数据。有68种（52%）首选治疗方案和64种（48%）非首选治疗方案。在64种非首选治疗中，43种（67%）是不适当的。接受首选治疗与非首选治疗的患者中，药物不良事件数量以及合并的负面后遗症结果有统计学显著下降（分别为2例对12例；P <.01和11例对23例；P <.01）。
有记录的β-内酰胺类过敏的退伍军人接受非首选抗生素治疗可能与出现负面结果的风险增加有关。在军事人员中，消除不必要的β-内酰胺类过敏将通过最佳抗生素选择提高战备状态并避免不必要的风险，加快完全恢复服役。
