Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia.


Penicillin allergy frequently impacts antibiotic choice. As beta-lactams are superior to vancomycin in treating methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, we examined the effect of reported penicillin allergy on clinical outcomes in patients with MSSA bacteremia.In this retrospective cohort study of adults with MSSA bacteremia admitted to a large tertiary care hospital, outcomes were examined according to reported penicillin allergy. Primary outcomes included 30-day and 90-day mortality rates. Multivariable regression models were developed to quantify the effect of reported penicillin allergy on mortality while adjusting for potential confounders.From 2010 to 2015, 318 patients with MSSA bacteremia were identified. Reported penicillin allergy had no significant effect on adjusted 30-day mortality (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.29-1.84; P = .51). Patients with reported penicillin allergy were more likely to receive vancomycin (38% vs 11%, P < .01), but a large number received cefazolin regardless of reported allergy (29 of 66, 44%). Mortality rates were highest among nonallergic patients receiving vancomycin (22.6% vs 7.4% for those receiving beta-lactams regardless of reported allergy, P < .01). In multivariable analysis, beta-lactam receipt was most strongly associated with survival (OR, 0.26; 95% CI, 0.12-0.54).Reported penicillin allergy had no significant effect on 30- or 90-day mortality. Non-penicillin-allergic patients receiving vancomycin for treatment of MSSA bacteremia had the highest mortality rates overall. Receipt of a beta-lactam was the strongest predictor of survival. These results underscore the importance of correct classification of patients with penicillin allergy and appropriate treatment with a beta-lactam when tolerated.





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Publication Info

Turner, Nicholas A, Rebekah Moehring, Christina Sarubbi, Rebekah H Wrenn, Richard H Drew, Coleen K Cunningham, Vance G Fowler, Deverick J Anderson, et al. (2018). Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia. Open forum infectious diseases, 5(3). 10.1093/ofid/ofy042 Retrieved from

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Nicholas Turner

Assistant Professor of Medicine

Rebekah Moehring

Associate Professor of Medicine

Richard Howard Drew

Professor in Medicine

Pharmacokinetics/pharmacodynamics of antimicrobials, antifungal use in compromised hosts, antimicrobial stewardship, prediction and therapy of multidrug-resistant pathogens, aerosolized antimicrobials


Vance Garrison Fowler

Florence McAlister Distinguished Professor of Medicine

Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia
Antibacterial Resistance
Pathogenesis of Bacterial Infections
Tropical medicine/International Health


Deverick John Anderson

Professor of Medicine

Hospital epidemiology, infection control, antibiotic stewardship, multidrug-resistant organisms, device-related infections, surgical site infections, catheter-associated bloodstream infections, cost of infections, infections in community hospitals

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