Cited by 829Antibiotic Use and ResistancePharmacovigilance and Adverse Drug ReactionsInfection Control in Healthcare

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Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: A cohort study.

Macy, Eric, Contreras, Richard·2014·Journal of Allergy and Clinical Immunology

DOI 10.1016/j.jaci.2013.09.021

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Abstract

Background Penicillin is the most common drug "allergy" noted at hospital admission, although it is often inaccurate.Objective We sought to determine total hospital days, antibiotic exposures, and the prevalence rates of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) in patients with and without penicillin "allergy" at hospital admission.Methods We performed a retrospective, matched cohort study of subjects admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012.Results It was possible to match 51,582 (99.6% of all possible cases) unique hospitalized subjects with penicillin "allergy" to 2 unique discharge diagnosis category-matched, sex-matched, age-matched, and date of admission-matched control subjects each. Cases with penicillin "allergy" averaged 0.59 (9.9%; 95% CI, 0.47-0.71) more total hospital days during 20.1 ± 10.5 months of follow-up compared with control subjects. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin (P < .0001) for each antibiotic compared with control subjects. Cases had 23.4% (95% CI, 15.6% to 31.7%) more C difficile, 14.1% (95% CI, 7.1% to 21.6%) more MRSA, and 30.1% (95% CI, 12.5% to 50.4%) more VRE infections than expected compared with control subjects.Conclusions A penicillin "allergy" history, although often inaccurate, is not a benign finding at hospital admission. Subjects with a penicillin "allergy" history spend significantly more time in the hospital. Subjects with a penicillin "allergy" history are exposed to significantly more antibiotics previously associated with C difficile and VRE. Drug "allergies" in general, but most those notably to penicillin, are associated with increased hospital use and increased C difficile, MRSA, and VRE prevalence.

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Authors: Macy, E., & Contreras, R.
Affiliations: Kaiser Permanente (US)
Corresponding author: Macy, Eric
ORCID: Macy, Eric
Venue: Journal of Allergy and Clinical Immunology
Publisher: Elsevier BV
Published: 2014-03
Volume: 133
Issue: 3
Pages: 790-796
ISSN: 0091-6749 (ISSN-L)
DOI: 10.1016/j.jaci.2013.09.021
OpenAlex: W2096270055
Cited by: 829
References: 34
Citations by year: 2026: 67 · 2025: 70 · 2024: 68 · 2023: 69 · 2022: 81 · 2021: 78 · 2020: 85 · 2019: 96 · 2018: 72 · 2017: 64 · 2016: 37 · 2015: 27 · 2014: 13
FWCI: 23.08
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Allergy and Clinical Immunology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
Keywords: penicillin allergy, drug hypersensitivity, Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, antibiotic exposure, length of hospital stay, hospitalized patients, fluoroquinolones, clindamycin, vancomycin, antibiotic stewardship
MeSH terms: Adult, Aged, Bacterial Infections, Delivery of Health Care, Drug Hypersensitivity, Female, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Penicillins, Retrospective Studies, Cohort Studies, Prevalence, Health Care Costs

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Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: A cohort study.

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