Clinical and economic burden of hospitalizations with registration of penicillin allergy


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Clinical and economic burden of hospitalizations with registration of penicillin allergy is a well-researched topic, it is to be used as a guide or framework for your Academic Research.


Background: Penicillin allergy is commonly reported, but only a minority of claimants has a confirmed di-agnosis. Nevertheless, patients labeled as having penicillin allergy are treated with second-line antibiotics,
which are more expensive and less effective, possibly increasing the risk of drug-resistant infections. Objective: To compare hospitalizations with and without registration of penicillin allergy concerning their morbidity and hospital resource use. Methods: We analyzed a national administrative database containing a registration of all Portuguese hos-
pitalizations from 2000 to 2014. All episodes occurring in adults with a penicillin allergy registration were compared with an equal number of hospitalizations without such registration and matched for inpatients’
age, sex, and main diagnosis. We compared those episodes concerning their length of stay, hospital price charges, comorbidities, and frequency of drug-resistant infections. Differences between medical and surgi-
cal hospitalizations were explored. Results: Hospitalizations with registration of penicillin allergy (n = 102,872) had a longer average length of stay than the remainder episodes (8 vs 7 days; P < .001) and higher hospital charges (3,809.0 vs 3,490.0 USD; P < .001). Inpatients with penicillin allergy registration also had a higher mean Charlson Comorbidity Index (0.91 vs 0.76; P < .001) and a significantly higher frequency of infections by several agents, including methicillin-
resistant Staphylococcus aureus, Enterococcus species, and Escherichia coli. Among surgical episodes, septicemia was 1.2-fold more frequent among penicillin allergy cases. Conclusion: Hospitalizations with registration of penicillin allergy are associated with increased economic
costs and frequency of infections by drug-resistant agents, reinforcing the need to establish a correct diag- nosis of penicillin allergy.


Drug hypersensitivity reactions represent 15% of all adverse drug
reactions.1 When these reactions are immunologically mediated, they
consist of drug allergies, which can present with a wide range of
clinical manifestations and with different levels of severity.2,3 Drug
allergy is commonly reported; although estimates vary among dif-
ferent populations, the frequency of self-reported drug allergy has
been found to be higher than 30% by some investigators.4,5 The
β-lactam class of antibiotics is one of the drug classes patients most
often claim to be allergic to; it is estimated that 8% of Americans
are labeled as being allergic to penicillins, but fewer than 5% of them
have a confirmed diagnosis.6 Therefore, although some true aller-
gic reactions might remain unidentified, overdiagnosis appears to
be a much more common phenomenon. Overdiagnosis of penicil-
lin allergy might be explained by several factors, such as the diversity
of clinical manifestations, misdiagnosis with other adverse reac-
tions or infectious rashes, and underperformance of confirmation
tests.7,8 In addition, in patients who are truly allergic to penicil-
lins, loss of sensitization over the years might occur.9
Overdiagnosis of penicillin allergy can have several clinical con-
sequences. Inpatients with such a label often receive second-line
treatments (such as vancomycin and fluoroquinolones), which are
less effective and associated with a higher risk of antibiotic-
resistant infections than penicillins.10,11 Those second-line antibiotics
also are more expensive and, in addition to the increased frequency of hospital readmissions, account for the higher costs ob-
served in the treatment of inpatients labeled with penicillin
allergy.10,12,13 Although the clinical and health care repercussions of
penicillin allergy labeling have been studied in the United States,
this issue remains poorly studied in Europe and nationwide studies
are lacking. In a previous study performed in children (under review),
we observed a significant association between having a registra-
tion of penicillin allergy and having more comorbidities and longer
hospitalizations. Therefore, we aimed to complement this assess-
ment by comparing the frequency of antibiotic-resistant infections,
length of stay, comorbidities, and hospitalization charges in adult
inpatients with and without registration of penicillin allergy on a
nationwide basis and over a period of 15 years. We also aimed to
assess whether there were differences between surgical and medical
hospitalizations for having a penicillin allergy label.


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Allergy and Clinical Immunology

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