Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study
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Abstract Objective To evaluate the relation between penicillin allergy and development of meticillin resistant Staphylococcus aureus (MRSA) and C difficile. Design Population based matched cohort study. Setting United Kingdom general practice (1995-2015). Participants 301 399 adults without previous MRSA or C difficile enrolled in the Health Improvement Network database: 64 141 had a penicillin allergy and 237 258 comparators matched on age, sex, and study entry time. Main outcome measures The primary outcome was risk of incident MRSA and C difficile. Secondary outcomes were use of β lactam antibiotics and β lactam alternative antibiotics. Results Among 64 141 adults with penicillin allergy and 237 258 matched comparators, 1365 developed MRSA (442 participants with penicillin allergy and 923 comparators) and 1688 developed C difficile (442 participants with penicillin allergy and 1246 comparators) during a mean 6.0 years of follow-up. Among patients with penicillin allergy the adjusted hazard ratio for MRSA was 1.69 (95% confidence interval 1.51 to 1.90) and for C difficile was 1.26 (1.12 to 1.40). The adjusted incidence rate ratios for antibiotic use among patients with penicillin allergy were 4.15 (95% confidence interval 4.12 to 4.17) for macrolides, 3.89 (3.66 to 4.12) for clindamycin, and 2.10 (2.08 to 2.13) for fluoroquinolones. Increased use of β lactam alternative antibiotics accounted for 55% of the increased risk of MRSA and 35% of the increased risk of C difficile. Conclusions Documented penicillin allergy was associated with an increased risk of MRSA and C difficile that was mediated by the increased use of β lactam alternative antibiotics. Systematically addressing penicillin allergies may be an important public health strategy to reduce the incidence of MRSA and C difficile among patients with a penicillin allergy label.
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Multiple studies have described that persons with reported penicillin or another ß-lactam antibiotic allergy have higher rates of surgical-site infections, methicillin-resistant Staphylococcus aureus infections, and higher medical care usage.
“Multiple studies have described that persons with reported penicillin or another ß-lactam antibiotic allergy have higher rates of surgical-site infections, methicillin-resistant Staphylococcus aureus infections, and higher medical care usage (653,662–664).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [663]
The Results and Discussion report a higher risk of MRSA among patients with a documented penicillin allergy. The paper does not report higher surgical-site infection rates, and its healthcare-visit and hospital-admission figures are baseline characteristics rather than a finding of higher medical care usage. The study also does not establish these outcomes for other β-lactam allergy labels. Page numbers are unavailable in our copy. (LLM, conf=0.87)
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- Authors
- Blumenthal, K. G., Lu, N., Zhang, Y., Li, Y., Walensky, R. P., & Choi, H. K.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Blumenthal, Kimberly G
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2018-06-27
- Volume
- 361
- Pages
- k2400
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC6019853
- OpenAlex
- W2810697168
- Cited by
- 357
- References
- 46
- Citations by year
- 2026: 38 · 2025: 49 · 2024: 49 · 2023: 42 · 2022: 41 · 2021: 43 · 2020: 41 · 2019: 44 · 2018: 10
- FWCI
- 26.10
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion, cc-by-nc)
- Funders
- American Academy of Allergy Asthma and Immunology (K01AI125631)
- National Institutes of Health
- National Institute of Allergy and Infectious Diseases (K01AI125631)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- penicillin allergy, methicillin-resistant Staphylococcus aureus, Clostridium difficile, Clostridium difficile infection, macrolides, clindamycin, fluoroquinolones, antibiotic use, general practice, antibiotic stewardship
- MeSH terms
- Adult, Aged, Clostridium Infections, Drug Hypersensitivity, Female, United Kingdom, Humans, Male, Middle Aged, Penicillins, Staphylococcal Infections, Cohort Studies, Incidence, Clostridioides difficile, Methicillin-Resistant Staphylococcus aureus
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