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Title: The revolving door: antibiotic allergy labelling in a tertiary care centre
Austin Authors: Knezevic, Brittany;Sprigg, Dustin;Seet, Jason;Trevenen, Michelle;Trubiano, Jason ;Smith, William;Jeelall, Yogesh;Vale, Sandra;Loh, Richard;McLean-Tooke, Andrew;Lucas, Michael
Affiliation: Department of Clinical Immunology, Royal Perth Hospital, Wellington St, Perth, Western Australia, Australia
Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Department of Immunology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
Australasian Society of Clinical Immunology and Allergy, Sydney, NSW, Australia
Department of Clinical Immunology, Princess Margaret Hospital, Perth, Western Australia, Australia
Pathwest laboratory, Queen Elizabeth II Campus, Perth, Western Australia, Australia
Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
Issue Date: Nov-2016
Date: 2016-08-17
Publication information: Internal Medicine Journal 2016; 46(11): 1276-1283
Abstract: BACKGROUND: Patients frequently report antibiotic allergies, however only 10% of labelled patients have a true allergy. AIM: We investigated the documentation of antibiotic "allergy" labels (AALs) and the effect of labelling on clinical outcomes, in a West Australian adult tertiary hospital. METHODS: Retrospective cross-sectional analysis of patients captured in the 2013 and 2014 National Antimicrobial Prescribing Surveys. Data was collected on documented antibiotic adverse drug reactions, antibiotic cost, prescribing appropriateness, prevalence of multi-drug resistant organisms, length of stay, intensive care admission, and readmissions. RESULTS: Of 687 patients surveyed, 278 (40%) were aged 70 or above, 365 (53%) were male and 279 (41%) were prescribed antibiotics. AALs were recorded in 122 (18%) patients and the majority were penicillin labels (n = 87; 71%). Details of AALs were documented for 80 of 141 (57%) individual allergy labels, with 61 describing allergic symptoms. Patients with beta-lactam allergy labels received fewer penicillins (p = 0.0002) and more aminoglycosides (p = 0.043) and metronidazole (p = 0.021) than patients without beta-lactam labels. Five patients received an antibiotic that was contraindicated according to their allergy status. Patients with AALs had significantly more hospital readmissions within 4 weeks (p = 0.001) and 6 months (p = 0.025) of discharge, compared with unlabelled patients. The majority (81%) of readmitted labelled patients had major infections. CONCLUSIONS: AALs are common but poorly documented in hospital records. Patients with AALs are significantly more likely to require alternative antibiotics, and hospital readmissions. There may be a role for antibiotic allergy delabelling to mitigate the clinical and economic burdens for patients with invalid allergy labels.
DOI: 10.1111/imj.13223
Journal: Internal Medicine Journal
PubMed URL:
Type: Journal Article
Subjects: Allergy
Drug Hypersensitivity
Appears in Collections:Journal articles

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