Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia.

Turner, Nicholas A

Moehring, Rebekah

Sarubbi, Christina

Wrenn, Rebekah H

Drew, Richard H

Cunningham, Coleen K

Fowler, Vance G

Anderson, Deverick J

2018-04-02T18:09:16Z

2018-04-02T18:09:16Z

2018-03

2018-04-02T18:09:15Z

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.

2328-8957

2328-8957

https://hdl.handle.net/10161/16481

eng

Oxford University Press (OUP)

Open forum infectious diseases

10.1093/ofid/ofy042

bacteremia

methicillin-susceptible Staphylococcus aureus

penicillin allergy

Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia.

Journal article

Turner, Nicholas A|0000-0003-0650-4894

Moehring, Rebekah|0000-0001-7741-6029

Drew, Richard H|0000-0003-0406-0804

Cunningham, Coleen K|0000-0002-7725-3052

Fowler, Vance G|0000-0002-8048-0897

Anderson, Deverick J|0000-0001-6882-5496

3

School of Medicine

Duke

Duke Global Health Institute

University Institutes and Centers

Institutes and Provost's Academic Units

Pathology

Clinical Science Departments

Pediatrics, Infectious Diseases

Pediatrics

Medicine, Infectious Diseases

Medicine

Staff

Published

5