Jani Yogini H, Chen Boqing, Powell Neil, Howard Philip, Sandoe Jonathan, West Robert, Lau Wallis Cy
Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom.
Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom.
J Infect. 2025 Feb;90(2):106367. doi: 10.1016/j.jinf.2024.106367. Epub 2025 Jan 3.
To assess the characteristics, risk factors and clinical impact of penicillin and other antibiotic allergy labels in general practice in the UK.
Population-based cohort study.
Primary care in the UK, 2000-2018.
Adults aged 18-100 years who were registered with their general practice for at least 12 months between 01-Jan-2000 and 31-Dec-2018 and followed until 25-Sep-2019.
The main outcomes include the annual prevalence and incidence of penicillin and other antibiotic allergy labels. Multinominal logistic regression was used to examine the characteristics associated with receiving an allergy label to different antibiotics. Cox regression modelling was used to compare the risk of resistant infections (methicillin-resistant Staphylococcus aureus [MRSA] and vancomycin-resistant enterococci) as well as Clostridioides difficile (C.difficile) infection between patients with and without allergy labels. The monthly proportion of patients who had a penicillin allergy test, either before their allergy label was recorded or within one year, was calculated to assess any impact of NICE penicillin allergy assessment recommendations (Clinical guideline [CG183]) in September 2014.
Both the prevalence and incidence of penicillin allergy label showed a pattern of initial growth followed by a decline. The prevalence reached a maximum of 8.25% in 2011, and the incidence peaked at 0.46% in 2004. Older age, being female, living in less deprived areas, belonging to a larger general practice, and having co-morbidities were associated with a higher chance of receiving a penicillin or other antibiotic allergy label. Patients with antibiotic allergy labels were more likely to receive alternative broad-spectrum antibiotics and had a higher risk of MRSA and C.difficile infections. The introduction of NICE drug allergy guideline did not alter the proportion of patients undergoing penicillin allergy assessment.
Penicillin and other antibiotic allergy labels are common and lead to radical change in the antibiotic prescribing practices and are associated with resistant and healthcare associated infections.
评估英国全科医疗中青霉素及其他抗生素过敏标签的特征、风险因素及临床影响。
基于人群的队列研究。
2000 - 2018年英国初级医疗。
年龄在18 - 100岁之间，于2000年1月1日至2018年12月31日在其全科医疗注册至少12个月，并随访至2019年9月25日的成年人。
主要结局包括青霉素及其他抗生素过敏标签的年患病率和发病率。采用多项逻辑回归分析与不同抗生素过敏标签相关的特征。使用Cox回归模型比较有和没有过敏标签的患者发生耐药感染（耐甲氧西林金黄色葡萄球菌[MRSA]和耐万古霉素肠球菌）以及艰难梭菌感染的风险。计算在过敏标签记录之前或之后一年内进行青霉素过敏试验的患者的月度比例，以评估2014年9月英国国家卫生与临床优化研究所（NICE）青霉素过敏评估建议（临床指南[CG183]）的影响。
青霉素过敏标签的患病率和发病率均呈现先上升后下降的趋势。患病率在2011年达到最高值8.25%，发病率在2004年达到峰值0.46%。年龄较大、女性、居住在贫困程度较低地区、隶属于较大的全科医疗机构以及患有合并症与获得青霉素或其他抗生素过敏标签的可能性较高相关。有抗生素过敏标签的患者更有可能接受替代广谱抗生素治疗，并且发生MRSA和艰难梭菌感染的风险更高。NICE药物过敏指南的引入并未改变接受青霉素过敏评估的患者比例。
青霉素及其他抗生素过敏标签很常见，会导致抗生素处方实践发生根本性改变，并与耐药感染及医疗相关感染有关。
