Moussa Ray, Miluski Tyler, Ghaffari Gisoo, Al-Shaikhly Taha
Section of Allergy, Asthma and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Intern Med J. 2025 Jun;55(6):993-1000. doi: 10.1111/imj.70057. Epub 2025 Apr 8.
Cystitis is a common infection in an otherwise healthy individual. Sulfonamide antibiotics are first-line treatment options. Sulfonamide allergy label (SAL) is the second most common antibiotic allergy label in electronic health records, yet its impact on clinical outcomes in patients with cystitis is not well-characterised.
The aim of this study is to characterise the impact of SAL on clinical outcomes of acute cystitis.
In this retrospective matched cohort study utilising the TriNetX US Collaborative Network (Cambridge, MA, USA), adult patients with cystitis were categorised based on their SAL status. The 28-day risks of acute pyelonephritis and Clostridium difficile infection and the risk of recurrent or relapsed cystitis (defined as cystitis 15-28 days post-indexed cystitis) were contrasted. Antibiotic prescription practices within 14 days of the index cystitis were also compared.
When comparing 19 767 patients with cystitis and SAL to an equal number of matched controls, more patients with SAL had acute pyelonephritis (RR 1.27; 95% CI 1.08-1.48; P = 0.003; corrected P = 0.027) within 28 days of index. More patients with SAL developed recurrent/relapsed cystitis 15-28 days post-indexed cystitis (RR 1.19; 95% CI 1.08-1.31; P = 0.001; corrected P = 0.009) as compared to controls. SAL altered antibiotic prescription practices with under-utilisation of trimethoprim and sulfamethoxazole and increased utilisation of alternative antibiotics, including fluoroquinolones and nitrofurantoin, which was associated with an increased risk of Clostridium difficile infection.
SAL alters antibiotic prescription practices and is associated with a slightly increased risk of poor outcomes in adult patients with cystitis.
膀胱炎是健康个体中常见的感染。磺胺类抗生素是一线治疗选择。磺胺类药物过敏标签（SAL）是电子健康记录中第二常见的抗生素过敏标签，但其对膀胱炎患者临床结局的影响尚未得到充分描述。
本研究旨在描述SAL对急性膀胱炎临床结局的影响。
在这项利用TriNetX美国协作网络（美国马萨诸塞州剑桥）进行的回顾性匹配队列研究中，成年膀胱炎患者根据其SAL状态进行分类。对比急性肾盂肾炎和艰难梭菌感染的28天风险以及复发性或复发性膀胱炎（定义为索引膀胱炎后15 - 28天的膀胱炎）的风险。还比较了索引膀胱炎后14天内的抗生素处方做法。
将19767例患有膀胱炎且有SAL的患者与同等数量的匹配对照进行比较时，更多有SAL的患者在索引后28天内发生急性肾盂肾炎（RR 1.27；95% CI 1.08 - 1.48；P = 0.003；校正P = 0.027）。与对照相比，更多有SAL的患者在索引膀胱炎后15 - 28天发生复发性/复发性膀胱炎（RR 1.19；95% CI 1.08 - 1.31；P = 0.001；校正P = 0.009）。SAL改变了抗生素处方做法，导致甲氧苄啶和磺胺甲恶唑使用不足，而包括氟喹诺酮类和呋喃妥因在内的替代抗生素使用增加，这与艰难梭菌感染风险增加有关。
SAL改变了抗生素处方做法，并且与成年膀胱炎患者不良结局风险略有增加相关。
