ANTIBIOTIC ALLERGIES IN PATIENTS WITH AND HIGH RISK FOR NEUTROPENIA: A QUALITY IMPROVEMENT OPPORTUNITY

Abstract

Introduction Standard therapy for patients with neutropenic fever is treatment with an antipseudomonal antibiotic. Patients with a history of self-reported penicillin allergy are often given alternative antibiotic regimens; however, up to 90% of these patients do not have IgE-mediated hypersensitivity and thus are inappropriately labeled as allergic. The effects of documented penicillin allergy on outcomes have been recognized: higher hospital charges, increased risk for surgical complications, and recently, increased rates of clostridium difficile infection and mortality in patients with hematologic malignancies. Methods A retrospective chart review was performed on patients admitted with ICD-9/10 diagnoses that identified them as having neutropenic fever/sepsis or acute leukemia. 1400 patients were identified and separated into two cohorts based on the presence of an antibiotic allergy. The outcomes investigated included AKI, clostridium difficile infection, mortality, MRSA and VRE colonizations. Results The absolute rates of AKI, clostridium difficile infection, mortality, MRSA and VRE colonizations were higher in the antibiotic allergy group compared to the non-allergy group: 6.8% difference in AKI, 1.9% in clostridium difficile infection, 7.6% in mortality, 0.2% in MRSA colonization, and 3.6% in VRE colonization. Conclusions We found higher rates of adverse events in patients at high risk of antibiotic use with documented antibiotic allergies. These findings confirm previously published work and extends the adverse outcomes of AKI, MRSA and VRE colonizations, further demonstrating that antibiotic allergy history is not benign. Thus, quality improvement opportunities exist to appropriately identify or disprove antibiotic allergies in patients who are at high risk for antibiotic use.