Outcomes in Hospitalized, Organ Transplant Patients with a Penicillin Allergy Label in the United States, 2005-2014

Abstract

Having a penicillin allergy label results in the use of alternative antibiotic regimens. We hypothesize that transplant patients with a penicillin allergy label have worse outcomes from receiving alternative regimens. Using data from the National Inpatient Sample database from 2005 through 2014, we used international classification of disease, ninth revision (ICD-9) codes to identify organ transplant (V42) patients who had a penicillin allergy label (V14.0) and who were hospitalized with a primary infectious process. We performed a retrospective analysis to compare their outcomes to those transplant patients that were treated for the same infections, but did not carry a penicillin allergy label. Of the 50,069 transplant patients identified, 1,170 (2.3%) had a penicillin allergy label. When compared to the control group, they had a higher overall rate of adverse effects from non-penicillin antibiotics (8.9% vs 6.3%; P = .0003). However, they had shorter length of hospital stay (4.9 vs 5.5 days; P = .0007), lower in-hospital mortality (1.6% vs 2.7%; P =.03), and lower rate of infections with multi-drug resistant organisms (0.3% vs 1%; P = .02). There were similar rates of MRSA infections (1.6% for both; P = .92), surgical wound infections (6% vs 5.5%; P = .52), and mean cost of hospitalization ($35,100.10 vs $39,711.80; P = .7). A similar trend was noted when evaluating patients within specific organ transplant groups. Transplant patients who carry a penicillin allergy label have a higher rate of adverse effects related to the use of non-penicillin antibiotics.