住院患者青霉素过敏标签与严重不良事件之间的关联：一项系统评价和荟萃分析。
Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis.
作者信息
Zhang Shipeng, Dong Tianyi, Xian Jiawen, Xiao Xinyue, Yuan Jiaqing, Zeng Tong, Deng Kuan, Fu Rui, Wang Hanyu, Jiang Yanjie, Li Xueying
机构信息
Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
出版信息
Front Pharmacol. 2025 Jan 6;15:1519522. doi: 10.3389/fphar.2024.1519522. eCollection 2024.
BACKGROUND
To date, several studies have demonstrated that erroneous labeling of Penicillin allergy (PAL) can significantly impact treatment options and result in adverse clinical outcomes, while other studies have reported no negative effects. Therefore, to systematically evaluate these effects and investigate the association between adverse clinical outcomes and the Penicillin label, we conducted this meta-analysis.
METHOD
Searches were conducted in the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to 13 July 2024. The search strategy utilized terms ("antibiotic allergy label," "penicillin allergy label," and "allergy label") and ("death," "readmission," "adverse outcome," and "clinical adverse outcome"). In the study selection process, the PICOS framework and stringent inclusion/exclusion criteria were applied. The quality of the initially included studies was independently assessed using the Newcastle-Ottawa Scale (NOS). Data from the included studies, including relative risk (RR) and 95% confidence intervals (CI), were extracted and analyzed using Stata 16.0. Sensitivity analyses were conducted to validate the results. Heterogeneity was assessed using the I and Cochrane Q tests, and publication bias was evaluated using Egger's test and funnel plot analysis.
RESULTS
A total of 497 relevant studies were identified through four databases. Following a thorough screening process, 11 studies encompassing 1,200,785 participants were ultimately included. The combined evidence suggests that penicillin allergy labeling is associated with increased mortality RR = 1.06 (95% CI 1.06-1.07, I = 0.00%), acute heart failure (RR = 1.19, 95% CI 1.09-1.30, τ = 0.00, I = 92.39%), ICU events (RR = 1.10, 95% CI 1.01-1.19, τ = 0.00, I = 57.09%), and mechanical ventilation events (RR = 1.16, 95% CI 1.09-1.24, τ = 0.00, I = 23.11%). Additionally, there was no significant association with readmissions (RR = 1.05, 95% CI 0.95-1.16, I = 0.00%).
CONCLUSION
Our findings indicate that penicillin allergy labels are associated with an increased risk of mortality in patients, as well as being linked to acute heart failure, heightened ICU requirements, and mechanical ventilation.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42024571535. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202457153.
背景
迄今为止，多项研究表明，青霉素过敏（PAL）的错误标注会显著影响治疗方案并导致不良临床结局，而其他研究则报告无负面影响。因此，为了系统评估这些影响并调查不良临床结局与青霉素标签之间的关联，我们进行了这项荟萃分析。
方法
在PubMed、Embase、Cochrane图书馆和Web of Science数据库中进行检索，检索时间从建库至2024年7月13日。检索策略使用了术语（“抗生素过敏标签”、“青霉素过敏标签”和“过敏标签”）以及（“死亡”、“再入院”、“不良结局”和“临床不良结局”）。在研究选择过程中，应用了PICOS框架和严格的纳入/排除标准。使用纽卡斯尔-渥太华量表（NOS）对最初纳入的研究质量进行独立评估。使用Stata 16.0提取并分析纳入研究的数据，包括相对风险（RR）和9�%置信区间（CI）。进行敏感性分析以验证结果。使用I²和Cochrane Q检验评估异质性，并使用Egger检验和漏斗图分析评估发表偏倚。
结果
通过四个数据库共识别出497项相关研究。经过全面筛选过程，最终纳入了11项研究，涉及1,200,785名参与者。综合证据表明，青霉素过敏标注与死亡率增加相关（RR = 1.06，95% CI 1.06 - 1.07，I² = 0.00%）、急性心力衰竭（RR = 1.19，95% CI 1.09 - 1.30，τ² = 0.00，I² = 92.39%）、重症监护病房事件（RR = 1.10，95% CI 1.01 - 1.19，τ² = 0.00，I² = 57.09%）和机械通气事件（RR = 1.16，95% CI 1.09 - 1.24，τ² = 0.00，I² = 百分之23.11）。此外，与再入院无显著关联（RR = 1.05，95% CI 0.95 - 1.16，I² = 0.00%）。
结论
我们的研究结果表明，青霉素过敏标签与患者死亡率增加风险相关，还与急性心力衰竭、更高的重症监护病房需求和机械通气有关。
系统评价注册
PROSPERO，标识符CRD42024571535。可从：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202457153获取。
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