A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs
Introduction: Penicillin allergy labels (PAL) are common in the hospital setting and are associated with worse clinical outcomes. Desensitization can be a useful strategy for allergic patients when alternative options are suboptimal or not available. The aim was to compare clinical outcomes of patie...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1260632/full |
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| author | Alicia Rodríguez-Alarcón Manuela Sanz de Mena Soukaina Sara Alanti Daniel Echeverría-Esnal Luisa Sorli Luisa Sorli Elena Sendra Adela Benítez-Cano Estela Membrilla Francesc Cots Robert Güerri-Fernández Robert Güerri-Fernández Ramón Adalia Juan Pablo Horcajada Juan Pablo Horcajada Fernando Escolano Santiago Grau Santiago Grau Silvia Gómez-Zorrilla Silvia Gómez-Zorrilla |
| author_facet | Alicia Rodríguez-Alarcón Manuela Sanz de Mena Soukaina Sara Alanti Daniel Echeverría-Esnal Luisa Sorli Luisa Sorli Elena Sendra Adela Benítez-Cano Estela Membrilla Francesc Cots Robert Güerri-Fernández Robert Güerri-Fernández Ramón Adalia Juan Pablo Horcajada Juan Pablo Horcajada Fernando Escolano Santiago Grau Santiago Grau Silvia Gómez-Zorrilla Silvia Gómez-Zorrilla |
| author_sort | Alicia Rodríguez-Alarcón |
| collection | DOAJ |
| description | Introduction: Penicillin allergy labels (PAL) are common in the hospital setting and are associated with worse clinical outcomes. Desensitization can be a useful strategy for allergic patients when alternative options are suboptimal or not available. The aim was to compare clinical outcomes of patients with PAL managed with antibiotic desensitization vs. those who received alternative non-beta-lactam antibiotic treatments.Methods: A retrospective 3:1 case-control study was performed between 2015–2022. Cases were adult PAL patients with infection who required antibiotic desensitization; controls were PAL patients with infection managed with an alternative antibiotic treatment. Cases and controls were adjusted for age, sex, infection source, and critical or non-critical medical services.Results: Fifty-six patients were included: 14 in the desensitization group, 42 in the control group. Compared to the control group, desensitized PAL patients had more comorbidities, with a higher Charlson index (7.4 vs. 5; p = 0.00) and more infections caused by multidrug-resistant (MDR) pathogens (57.1% vs. 28.6%; p = 0.05). Thirty-day mortality was 14.3% in the desensitized group, 28.6% in the control group (p = 0.24). Clinical cure occurred in 71.4% cases and 54.8% controls (p = 0.22). Four control patients selected for MDR strains after alternative treatment; selection of MDR strains did not occur in desensitized patients. Five controls had antibiotic-related adverse events, including Clostridioides difficile or nephrotoxicity. No antibiotic-related adverse events were found in the study group. In multivariate analysis, no differences between groups were observed for main variables.Conclusion: Desensitization was not associated with worse clinical outcomes, despite more severe patients in this group. Our study suggests that antibiotic desensitization may be a useful Antimicrobial Stewardship tool for the management of selected PAL patients. |
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| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-03-11T07:05:25Z |
| publishDate | 2023-11-01 |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-467edd1e1e73488b9468f0873b3085f52023-11-17T08:56:04ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-11-011410.3389/fphar.2023.12606321260632A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship ProgramsAlicia Rodríguez-Alarcón0Manuela Sanz de Mena1Soukaina Sara Alanti2Daniel Echeverría-Esnal3Luisa Sorli4Luisa Sorli5Elena Sendra6Adela Benítez-Cano7Estela Membrilla8Francesc Cots9Robert Güerri-Fernández10Robert Güerri-Fernández11Ramón Adalia12Juan Pablo Horcajada13Juan Pablo Horcajada14Fernando Escolano15Santiago Grau16Santiago Grau17Silvia Gómez-Zorrilla18Silvia Gómez-Zorrilla19Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainInfectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainInfectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainPharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainInfectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainCenter for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainInfectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainDepartment of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Hospital del Mar Research Institute, Barcelona, SpainSurgery Service, Parc de Salut Mar. IHospital del Mar Research Institute, Barcelona, SpainManagement Control Department, Hospital del Mar-Parc de Salut Mar, Barcelona, SpainInfectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainCenter for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainDepartment of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Hospital del Mar Research Institute, Barcelona, SpainInfectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainCenter for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainDepartment of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Hospital del Mar Research Institute, Barcelona, SpainPharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainCenter for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainInfectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, SpainCenter for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainIntroduction: Penicillin allergy labels (PAL) are common in the hospital setting and are associated with worse clinical outcomes. Desensitization can be a useful strategy for allergic patients when alternative options are suboptimal or not available. The aim was to compare clinical outcomes of patients with PAL managed with antibiotic desensitization vs. those who received alternative non-beta-lactam antibiotic treatments.Methods: A retrospective 3:1 case-control study was performed between 2015–2022. Cases were adult PAL patients with infection who required antibiotic desensitization; controls were PAL patients with infection managed with an alternative antibiotic treatment. Cases and controls were adjusted for age, sex, infection source, and critical or non-critical medical services.Results: Fifty-six patients were included: 14 in the desensitization group, 42 in the control group. Compared to the control group, desensitized PAL patients had more comorbidities, with a higher Charlson index (7.4 vs. 5; p = 0.00) and more infections caused by multidrug-resistant (MDR) pathogens (57.1% vs. 28.6%; p = 0.05). Thirty-day mortality was 14.3% in the desensitized group, 28.6% in the control group (p = 0.24). Clinical cure occurred in 71.4% cases and 54.8% controls (p = 0.22). Four control patients selected for MDR strains after alternative treatment; selection of MDR strains did not occur in desensitized patients. Five controls had antibiotic-related adverse events, including Clostridioides difficile or nephrotoxicity. No antibiotic-related adverse events were found in the study group. In multivariate analysis, no differences between groups were observed for main variables.Conclusion: Desensitization was not associated with worse clinical outcomes, despite more severe patients in this group. Our study suggests that antibiotic desensitization may be a useful Antimicrobial Stewardship tool for the management of selected PAL patients.https://www.frontiersin.org/articles/10.3389/fphar.2023.1260632/fullantibiotic desensitizationpenicillinsbeta-lactamsantimicrobial stewardship programshypersensitivityallergy |
| spellingShingle | Alicia Rodríguez-Alarcón Manuela Sanz de Mena Soukaina Sara Alanti Daniel Echeverría-Esnal Luisa Sorli Luisa Sorli Elena Sendra Adela Benítez-Cano Estela Membrilla Francesc Cots Robert Güerri-Fernández Robert Güerri-Fernández Ramón Adalia Juan Pablo Horcajada Juan Pablo Horcajada Fernando Escolano Santiago Grau Santiago Grau Silvia Gómez-Zorrilla Silvia Gómez-Zorrilla A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs Frontiers in Pharmacology antibiotic desensitization penicillins beta-lactams antimicrobial stewardship programs hypersensitivity allergy |
| title | A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs |
| title_full | A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs |
| title_fullStr | A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs |
| title_full_unstemmed | A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs |
| title_short | A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs |
| title_sort | retrospective case control study to evaluate the use of beta lactam desensitization in the management of penicillin allergic patients a potential strategy for antimicrobial stewardship programs |
| topic | antibiotic desensitization penicillins beta-lactams antimicrobial stewardship programs hypersensitivity allergy |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1260632/full |
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