Background

Penicillins (PCNs) are a first-line treatment option for bacterial pneumonia. PCN allergy label can delay antimicrobial treatment and result in the use of alternative antibiotic regimens risking an inadequate response to treatment and potentially increased adverse drug reactions.

Objective

To investigate the impact of PCN allergy label on clinical outcomes of bacterial pneumonia.

Methods

This retrospective cohort study used TriNetX, a web-based tool for population cohort research, to identify adult patients with and without PCN allergy label diagnosed with bacterial pneumonia. Cohorts were matched for baseline demographics and chronic medical conditions. The 30-day risks of hospitalization, acute respiratory failure, intubation, need for intensive level of care, and mortality were compared. Antibiotics used and their possible adverse reactions were explored.

Results

After matching, there were 68,748 patients in each cohort. Patients with bacterial pneumonia with PCN allergy label had higher risks of hospitalization (risk ratio [RR], 1.23; 95% confidence interval [CI], 1.22-1.24), acute respiratory failure (RR, 1.14; 95% CI, 1.12-1.15), intubation (RR, 1.18; 95% CI, 1.13-1.22), intensive level of care (RR, 1.11; 95% CI, 1.08-1.14), and mortality (RR, 1.08; 95% CI, 1.04-1.13) compared with patients without PCN allergy label. Patients with PCN allergy label had decreased use of PCNs and cephalosporins and increased utilization of other antibiotic classes compared with patients without PCN allergy label. PCN allergy label was also associated with increased risk of adverse drug reactions.

Conclusion

PCN allergy label is associated with worse clinical outcomes in bacterial pneumonia, and risk mitigation strategies should be considered.

中文翻译：

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青霉素过敏标签与细菌性肺炎的较差临床结果相关

背景

青霉素 (PCN) 是细菌性肺炎的一线治疗选择。PCN 过敏标签可能会延迟抗菌治疗，并导致使用替代抗生素治疗方案，从而可能对治疗反应不充分，并可能增加不良药物反应。

客观的

探讨 PCN 过敏标签对细菌性肺炎临床结局的影响。

方法

这项回顾性队列研究使用 TriNetX（一种基于网络的人群队列研究工具）来识别诊断为细菌性肺炎的带有和不带有 PCN 过敏标签的成年患者。队列与基线人口统计数据和慢性疾病相匹配。比较了住院、急性呼吸衰竭、插管、需要重症监护和死亡率的 30 天风险。探讨了使用的抗生素及其可能的不良反应。

结果

匹配后，每个队列中有 68,748 名患者。具有 PCN 过敏标签的细菌性肺炎患者住院风险较高（风险比 [RR]，1.23；95% 置信区间 [CI]，1.22-1.24）、急性呼吸衰竭（RR，1.14；95% CI，1.12-1.15） )、插管（RR，1.18；95% CI，1.13-1.22）、重症监护（RR，1.11；95% CI，1.08-1.14）和死亡率（RR，1.08；95% CI，1.04-1.13）与没有 PCN 过敏标签的患者相比。与没有 PCN 过敏标签的患者相比，带有 PCN 过敏标签的患者减少了 PCN 和头孢菌素的使用，增加了其他抗生素类别的使用。PCN 过敏标签也与药物不良反应风险增加有关。

结论

PCN 过敏标签与细菌性肺炎的临床结果较差有关，应考虑降低风险的策略。