Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia.

Published online

Journal Article

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Full Text

Duke Authors

Cited Authors

  • Turner, NA; Moehring, R; Sarubbi, C; Wrenn, RH; Drew, RH; Cunningham, CK; Fowler, VG; Anderson, DJ

Published Date

  • March 2018

Published In

Volume / Issue

  • 5 / 3

Start / End Page

  • ofy042 -

PubMed ID

  • 29594180

Pubmed Central ID

  • 29594180

International Standard Serial Number (ISSN)

  • 2328-8957

Digital Object Identifier (DOI)

  • 10.1093/ofid/ofy042

Language

  • eng

Conference Location

  • United States