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Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia.

Publication ,  Journal Article
Turner, NA; Moehring, R; Sarubbi, C; Wrenn, RH; Drew, RH; Cunningham, CK; Fowler, VG; Anderson, DJ
Published in: Open Forum Infect Dis
March 2018

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.

Duke Scholars

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Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

March 2018

Volume

5

Issue

3

Start / End Page

ofy042

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences
 

Citation

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Chicago
ICMJE
MLA
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Turner, N. A., Moehring, R., Sarubbi, C., Wrenn, R. H., Drew, R. H., Cunningham, C. K., … Anderson, D. J. (2018). Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia. Open Forum Infect Dis, 5(3), ofy042. https://doi.org/10.1093/ofid/ofy042
Turner, Nicholas A., Rebekah Moehring, Christina Sarubbi, Rebekah H. Wrenn, Richard H. Drew, Coleen K. Cunningham, Vance G. Fowler, and Deverick J. Anderson. “Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia.Open Forum Infect Dis 5, no. 3 (March 2018): ofy042. https://doi.org/10.1093/ofid/ofy042.
Turner NA, Moehring R, Sarubbi C, Wrenn RH, Drew RH, Cunningham CK, et al. Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia. Open Forum Infect Dis. 2018 Mar;5(3):ofy042.
Turner, Nicholas A., et al. “Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia.Open Forum Infect Dis, vol. 5, no. 3, Mar. 2018, p. ofy042. Pubmed, doi:10.1093/ofid/ofy042.
Turner NA, Moehring R, Sarubbi C, Wrenn RH, Drew RH, Cunningham CK, Fowler VG, Anderson DJ. Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia. Open Forum Infect Dis. 2018 Mar;5(3):ofy042.
Journal cover image

Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

March 2018

Volume

5

Issue

3

Start / End Page

ofy042

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences