International Doctorate School, Universidad Rey Juan Carlos, Madrid, Spain.
Department of Pharmacy, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
Int Arch Allergy Immunol. 2022;183(5):498-506. doi: 10.1159/000520644. Epub 2021 Dec 17.
Penicillin allergy is a common problem in the management of infectious diseases. The aim of this study was to determine the impact of penicillin allergy on length of hospital stay (LOHS) among hospitalized adult patients and on in-hospital mortality at a national level.
A retrospective cohort study of adult patients discharged from the Spanish Hospital System between 2006 and 2015 was conducted using the Minimum Basic Data Set (MBDS). We compared LOHS and in-hospital mortality of adult patients whose records contained penicillin allergy code V14.0 (International Classification of Diseases, Ninth Revision, Clinical Modification) as a secondary diagnosis, with a random sample without such a code.
We identified 981,291 admissions with code V14.0, which corresponded to 2.63% of all hospitalizations. Adults patients with a penicillin allergy label were significantly older than patients without such a label, with a median of 70 years (interquartile range [IQR]: 51-80) versus 63 years (IQR: 40-77). The proportion of women and the prevalence of infectious diseases were higher in the group with a penicillin allergy label (61.40% vs. 53.84%; 34.04% vs. 30.01%; respectively). We found a higher median Elixhauser-Van Walraven score in hospitalized patients with an allergy label. The median LOHS for hospitalizations with a penicillin allergy label (5 [IQR: 2-9]) was significantly longer than that in those without such a label (4 [IQR: 2-9]). Multivariate analysis showed an increase in LOHS due to the penicillin allergy label (odds ratio [OR] [95% confidence interval [CI]: 1.061 [1.057-1.065]) and a decrease in mortality in penicillin allergy records (OR [95% CI]: 0.834 [0.825-0.844]).
In our study, the prevalence of a penicillin allergy label in hospitalized patients, using the MBDS, is low. Hospitalizations with an allergy label was associated with a longer LOHS. However, penicillin-allergic patients did not show higher mortality rates. Inaccurate reporting of penicillin allergies may have an impact on healthcare resources.
青霉素过敏是感染性疾病管理中的常见问题。本研究旨在确定在全国范围内，青霉素过敏对住院成人患者的住院时间（LOHS）和院内死亡率的影响。
使用最小基本数据集（MBDS）对 2006 年至 2015 年期间从西班牙医院系统出院的成年患者进行回顾性队列研究。我们比较了记录中包含青霉素过敏代码 V14.0（国际疾病分类，第九版，临床修订版）作为次要诊断的成年患者的 LOHS 和院内死亡率，与没有此类代码的随机样本进行比较。
我们确定了 981291 例记录有 V14.0 代码的住院患者，占所有住院患者的 2.63%。有青霉素过敏标签的成年患者明显比没有该标签的患者年龄大，中位数为 70 岁（四分位距[IQR]：51-80），而 63 岁（IQR：40-77）。有过敏标签组的女性比例和传染病患病率较高（分别为 61.40%比 53.84%；34.04%比 30.01%）。我们发现过敏标签组的住院患者的 Elixhauser-Van Walraven 评分中位数较高。有青霉素过敏标签的住院患者的 LOHS 中位数（5 [IQR：2-9]）明显长于没有该标签的患者（4 [IQR：2-9]）。多变量分析显示，青霉素过敏标签导致 LOHS 增加（比值比[OR] [95%置信区间[CI]：1.061 [1.057-1.065]），而青霉素过敏记录的死亡率降低（OR [95% CI]：0.834 [0.825-0.844]）。
在我们的研究中，使用 MBDS 的住院患者中青霉素过敏标签的患病率较低。带有过敏标签的住院治疗与较长的 LOHS 相关。然而，青霉素过敏患者的死亡率并没有更高。青霉素过敏的不准确报告可能会影响医疗保健资源的使用。
