报告的β-内酰胺类药物过敏对实体器官移植受者临床结局及抗生素使用的影响
The Impact of Reported β-Lactam Allergy on Clinical Outcomes and Antibiotic Use Among Solid Organ Transplant Recipients.
作者信息
Zhang Helen L, Anesi Judith A, Hamilton Keith W, Cressman Leigh, Bilker Warren B, Lautenbach Ebbing
机构信息
Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
出版信息
Open Forum Infect Dis. 2022 Jul 29;9(8):ofac384. doi: 10.1093/ofid/ofac384. eCollection 2022 Aug.
BACKGROUND
Reported β-lactam allergies (BLAs) are common and frequently inaccurate, but there are limited data on the clinical implications of BLA among solid organ transplant (SOT) recipients. We examined the impact of BLA on clinical outcomes and antibiotic use among SOT recipients.
METHODS
This retrospective cohort study included adult patients undergoing single-organ heart, kidney, liver, lung, or pancreas transplant at a United States academic medical center from 1 April 2017 to 31 December 2020. Demographic and clinical data were collected from the electronic health record. Multivariate median regression was performed to evaluate the association between BLA and days alive and out of the hospital in the first 180 days posttransplant (DAOH180). Multivariate logistic regression was performed to evaluate the association between BLA and antibiotic use.
RESULTS
Among 1700 SOT recipients, 285 (16.8%) had a BLA at the time of transplant. BLA was not associated with DAOH180 (adjusted median difference, -0.8 days [95% confidence interval {CI}, -2.7 to 1.2]; = .43). Patients with BLA were more likely to receive intravenous vancomycin (adjusted odds ratio [aOR], 1.8 [95% CI, 1.3-2.6]; < .001), clindamycin (aOR, 9.9 [95% CI, 5.1-18.9]; < .001), aztreonam (aOR, 19.6 [95% CI, 5.9-64.4]; < .001), fluoroquinolones (aOR, 3.8 [95% CI, 2.8-5.0]; < .001), or aminoglycosides (aOR, 3.9 [95% CI, 2.5-6.2]; < .001).
CONCLUSIONS
BLA was associated with use of β-lactam alternative antibiotics but not DAOH180 among SOT recipients.
背景
报告的β-内酰胺类抗生素过敏（BLA）情况很常见且常常不准确，但关于实体器官移植（SOT）受者中BLA的临床影响的数据有限。我们研究了BLA对SOT受者临床结局和抗生素使用的影响。
方法
这项回顾性队列研究纳入了2017年4月1日至2020年12月31日在美国一家学术医疗中心接受单器官心脏、肾脏、肝脏、肺或胰腺移植的成年患者。从电子健康记录中收集人口统计学和临床数据。进行多变量中位数回归以评估BLA与移植后前180天存活且出院天数（DAOH180）之间的关联。进行多变量逻辑回归以评估BLA与抗生素使用之间的关联。
结果
在1700名SOT受者中，285名（16.8%）在移植时存在BLA。BLA与DAOH180无关（调整后的中位数差异为-0.8天[95%置信区间{CI}，-2.7至1.2]；P = 0.43）。有BLA的患者更有可能接受静脉注射万古霉素（调整后的优势比[aOR]，1.8[95%CI，1.3 - 2.6]；P < 0.001）、克林霉素（aOR，9.9[95%CI，5.1 - 18.9]；P < 0.001）、氨曲南（aOR，19.6[95%CI，5.9 - 64.4]；P < 0.001）、氟喹诺酮类药物（aOR，3.8[95%CI，2.8 - 5.0]；P < 0.001）或氨基糖苷类药物（aOR，3.9[95%CI，2.5 - 6.2]；P < 0.001）。
结论
在SOT受者中，BLA与β-内酰胺类抗生素替代药物的使用有关，但与DAOH180无关。
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