Lanoue Derek, van Walraven Carl
Department of Medicine, University of Ottawa, Ottawa, Canada.
Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada; International Credential Evaluation Service (ICES), British Columbia, Canada.
Ann Allergy Asthma Immunol. 2022 Jun;128(6):705-712. doi: 10.1016/j.anai.2022.03.010. Epub 2022 Mar 12.
Many antibiotic allergy labels (AAL) are invalid. Excluding true allergy in people with AAL ("delabeling") could improve health outcomes and decrease costs. Several studies with limited covariate adjustment have associated AAL with a prolonged hospital length of stay (LOS).
This study determined whether AAL's association with LOS persisted after extensive adjustment for potential confounders and covariates.
All nonpsychiatric admissions to a tertiary care teaching hospital from 2012 to 2015 were included. Generalized estimating equation methods were used to model the daily discharge likelihood as a function of AAL and other important factors (death risk score, daily discharge score, daily severity of illness score, antibiotic use, hospital day and location, weekend-holiday status, and service).
A total of 111,611 admissions (76,460 patients) were studied, in which 16,489 (14.8%) had recorded AAL. Patients with an AAL had a notably greater disease burden: they were older and had more comorbidities, greater health system utilization, and higher death risk. In the univariate analysis, AAL was associated with a significantly decreased daily discharge likelihood (odds ratio [OR], 0.93; [95% confidence interval, 0.90-0.95]). After adjustment for potential confounders and covariates, AAL was not associated with daily discharge likelihood (adjusted OR [aOR] without antibiotics: 1.00 [0.98-1.03]; aOR with antibiotics: 1.02 [0.99-1.04]). Similar results were also seen with penicillin AAL (aOR without antibiotics: 0.99 [0.95-1.02]; aOR with antibiotics: 1.00 [0.96-1.03]).
Antibiotic allergy label was strongly associated with a greater disease burden. After adjusting for important covariates, our analysis found no significant association between AAL and hospital LOS.
许多抗生素过敏标签（AAL）是无效的。在有AAL的人群中排除真正的过敏（“去除标签”）可以改善健康结局并降低成本。几项协变量调整有限的研究将AAL与延长的住院时间（LOS）联系起来。
本研究确定在对潜在混杂因素和协变量进行广泛调整后，AAL与LOS的关联是否仍然存在。
纳入2012年至2015年一家三级护理教学医院的所有非精神科住院患者。使用广义估计方程方法将每日出院可能性建模为AAL和其他重要因素（死亡风险评分、每日出院评分、每日疾病严重程度评分、抗生素使用、住院天数和地点、周末-节假日状态以及科室）的函数。
共研究了111,611例住院患者（76,460名患者），其中16,489例（14.8%）记录有AAL。有AAL的患者疾病负担明显更重：他们年龄更大，合并症更多，卫生系统利用率更高，死亡风险也更高。在单变量分析中，AAL与每日出院可能性显著降低相关（比值比[OR]，0.93；[95%置信区间，0.90 - 0.95]）。在对潜在混杂因素和协变量进行调整后，AAL与每日出院可能性无关（无抗生素时调整后的OR[aOR]：1.00[0.98 - 1.03]；使用抗生素时aOR：1.02[0.99 - 1.04]）。青霉素AAL也有类似结果（无抗生素时aOR：0.99[0.95 - 1.02]；使用抗生素时aOR：1.00[0.96 - 1.03]）。
抗生素过敏标签与更大的疾病负担密切相关。在对重要协变量进行调整后，我们的分析发现AAL与住院LOS之间无显著关联。
