Azmy Veronica, Lundsberg Lisbet S, Culhane Jennifer, Kwah Jason, Partridge Caitlin, Son Moeun
Section of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
Am J Perinatol. 2024 May;41(S 01):e2051-e2057. doi: 10.1055/a-2096-5002. Epub 2023 May 21.
Pregnant individuals are likely to need antibiotics during the peripartum period. For pregnant individuals who report a history of penicillin allergy, non-β-lactam antibiotics are often administered. Compared with first-line β-lactam antibiotics, alternative antibiotics can be less effective, more toxic, and more costly. It remains unclear if being labeled with a penicillin allergy is associated with adverse maternal and neonatal outcomes.
We conducted a retrospective cohort study of all pregnant patients who delivered a viable singleton between 24 and 42 weeks of gestation at a large academic hospital from 2013 to 2021. We compared patients who had a documented penicillin allergy history in their electronic medical record versus those who did not and examined whether there were significant differences in maternal outcomes and neonatal outcomes. Bivariable and multivariable analyses were performed.
Of 41,943 eligible deliveries included in the analysis, 4,705 (11.2%) patients had a penicillin allergy history documented in their electronic medical record and 37,238 (88.8%) did not. Even after adjusting for potential confounders, patients with a documented penicillin allergy had a higher risk of postpartum endometritis (adjusted odds ratio [aOR]: 1.46; 95% confidence interval [CI]: 1.01-2.11) and a higher risk of their neonates having a postnatal hospital stay lasting more than 72 hours (aOR: 1.10; 95% CI: 1.02-1.18). There were no significant differences seen in the other maternal and neonatal outcomes in both bivariable and multivariable analyses.
Pregnant patients who are labeled as having a penicillin allergy are more likely to have postpartum endometritis, and neonates born to mothers who are labeled as having a penicillin allergy are more likely to have a postnatal hospital stay lasting more than 72 hours. There were no other significant differences seen in pregnant patients and their newborns whether they were labeled as having a penicillin allergy history or not. However, pregnant individuals with a penicillin allergy documented in their medical record were significantly more likely to receive alternative non-β lactam antibiotics, and may have benefitted from having more details of their allergy history available as well as proper allergy verification with testing.
· It is unclear whether pregnant individuals labeled with penicillin allergies have worse obstetric outcomes.. · These individuals were significantly more likely to have endometritis and their newborns hospitalized for >72 hours.. · They were significantly more likely to receive alternative non-β lactam antibiotics than those without documented allergies..
孕期女性在围产期可能需要使用抗生素。对于有青霉素过敏史的孕妇，通常会使用非β-内酰胺类抗生素。与一线β-内酰胺类抗生素相比，替代抗生素可能效果较差、毒性更大且成本更高。目前尚不清楚被标记为青霉素过敏是否与不良的母婴结局相关。
我们对2013年至2021年在一家大型学术医院妊娠24至42周分娩活产单胎的所有孕妇进行了一项回顾性队列研究。我们比较了电子病历中有青霉素过敏史记录的患者和没有该记录的患者，并检查母婴结局是否存在显著差异。进行了双变量和多变量分析。
在纳入分析的41943例符合条件的分娩中，4705例（11.2%）患者的电子病历中有青霉素过敏史记录，37238例（88.8%）没有。即使在调整潜在混杂因素后，有青霉素过敏记录的患者发生产后子宫内膜炎的风险更高（调整后的优势比[aOR]：1.46；95%置信区间[CI]：1.01-2.11），其新生儿出生后住院时间超过72小时的风险也更高（aOR：1.10；95%CI：1.02-1.18）。在双变量和多变量分析中，其他母婴结局均未发现显著差异。
被标记为有青霉素过敏的孕妇更有可能发生产后子宫内膜炎，被标记为有青霉素过敏的母亲所生的新生儿更有可能有超过72小时的出生后住院时间。无论是否被标记为有青霉素过敏史，孕妇及其新生儿均未发现其他显著差异。然而，病历中有青霉素过敏记录的孕妇更有可能接受替代的非β-内酰胺类抗生素，若能获取更多过敏史细节并进行适当的过敏检测验证，她们可能会从中受益。
· 被标记为青霉素过敏的孕妇产科结局是否更差尚不清楚。· 这些孕妇发生子宫内膜炎的可能性显著更高，其新生儿住院时间超过72小时。· 与无过敏记录的孕妇相比，她们接受替代非β-内酰胺类抗生素的可能性显著更高。
