Documented betalactum allergies not associated with long-term odds of mortality suggests JAMA study
Researchers have found that while beta-lactam (BL) allergies are not associated with increased long-term mortality, they are linked to higher rates of antibiotic-resistant infections. This finding is based on a longitudinal retrospective cohort study conducted at a regional health care system in western Pennsylvania, highlighting the need for accurate allergy documentation and cautious antibiotic stewardship. This study was published in JAMA Network Open by Matthew P. and colleagues.
BL allergies are the most common drug allergies worldwide, often reported erroneously. These allergies are known risk factors for adverse drug events and antibiotic-resistant infections during inpatient care, but their long-term outcomes have been less understood. This study aimed to evaluate the long-term clinical outcomes of patients with documented BL allergies.
The study analyzed electronic health records of patients with an initial diagnosis of sepsis, pneumonia, or urinary tract infection between 2007 and 2008. These patients were followed up until death or the end of 2018. Data analysis was performed from January 2022 to January 2024. The presence of any BL class antibiotic allergy in the patient's electronic health record was evaluated at their earliest recorded health care encounter.
The primary outcome was all-cause mortality, obtained from the Social Security Death Index. Secondary outcomes included infections with methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, or vancomycin-resistant Enterococcus (VRE), as well as the severity and occurrence of acute kidney injury (AKI). Odds of these outcomes were evaluated using generalized estimating equations.
• The study included 20,092 patients (mean age 62.9 years; 60.9% female). Of these, 4211 (21.0%) had a documented BL allergy, and 15,881 (79.0%) did not. The cohort comprised 17.5% Black, 76.4% White, and 6.0% other races.
• BL allergies were not significantly associated with the odds of mortality (OR, 1.02; 95% CI, 0.96-1.09).
• BL allergies were associated with increased odds of MRSA infection (OR, 1.44; 95% CI, 1.36-1.53), VRE infection (OR, 1.18; 95% CI, 1.05-1.32), and the pooled rate of the three antibiotic-resistant infections (OR, 1.33; 95% CI, 1.30-1.36).
• There was no significant association with C. difficile infection (OR, 1.04; 95% CI, 0.94-1.16).
• There was also no significant association with stage 2 and 3 AKI (OR, 1.02; 95% CI, 0.96-1.10) or stage 3 AKI (OR, 1.06; 95% CI, 0.98-1.14).
The findings indicate that while BL allergies do not impact long-term mortality, they do significantly increase the risk of antibiotic-resistant infections such as MRSA and VRE. This underscores the importance of precise allergy documentation and the reduction of unnecessary BL antibiotic avoidance, which may help in managing and preventing resistant infections.
Documented BL allergies were not linked to increased long-term mortality but were associated with higher rates of antibiotic-resistant infections. Health systems should prioritize accurate allergy documentation and minimize unnecessary avoidance of BL antibiotics to mitigate the risks of antibiotic resistance.
Reference:
Gray, M. P., Kellum, J. A., Kirisci, L., Boyce, R. D., & Kane-Gill, S. L. (2024). Long-term outcomes associated with β-lactam allergies. JAMA Network Open, 7(5), e2412313. https://doi.org/10.1001/jamanetworkopen.2024.12313
