Patients With Penicillin Allergy Label Have Worse Bacterial Pneumonia Outcomes

In patients with bacterial pneumonia, having a penicillin (PCN) allergy label is associated with worse clinical outcomes, including hospitalization, acute respiratory failure, intubation, and death, according to study findings published in The Journal of Allergy and Clinical Immunology.

Researchers hypothesized that because patients having a PCN allergy label may experience a delay in antibiotic administration and may end up receiving alternative and broader-spectrum antibiotic regimens for bacterial pneumonia, such patients would have an increased risk for worse clinical outcomes. To test this hypothesis, they leveraged a large population-based database to explore the possible effects of the PCN allergy label on outcomes. The researchers also examined patterns of antibiotic use in these patients and the potential adverse effects of antimicrobial therapy.

The investigators used TriNetX — a web-based tool used for population cohort research — to identify adult patients with and without a PCN allergy label who had been diagnosed with bacterial pneumonia. The 2 patient cohorts were matched with respect to baseline demographics and chronic medical conditions, with each cohort including 68,748 patients.

The investigators compared the 2 patient cohorts for 30-day risks for hospitalization, acute respiratory failure, intubation, care in an intensive care unit (ICU), and mortality following a diagnosis of bacterial pneumonia. The researchers also evaluated all of the antibiotics used and their possible adverse effects.

Results of the study showed that patients with bacterial pneumonia with PCN allergy label had higher a risk for hospitalization (risk ratio [RR], 1.23; 95% CI, 1.22-1.24;
P <.001), acute respiratory failure (RR, 1.14; 95% CI, 1.12-1.15; P <.001), intubation (RR, 1.18; 95% CI, 1.13-1.22; P <.001), ICU care (RR, 1.11; 95% CI, 1.08-1.14;
P <.001), and mortality (RR, 1.08; 95% CI, 1.04-1.13; P <.001), compared with those without PCN allergy label.

Further, decreased use of PCNs and cephalosporins, along with increased utilization of other classes of antibiotics, was reported among patients with PCN allergy label compared with those without PCN allergy label. PCN allergy label was also associated with an increased risk for adverse drug reactions.

Several limitations of the current study warrant mention. The investigation was limited by reliance on ICD-10 and CPT codes, as well as by the inability of the TriNetX platform to establish the effect of PCN allergy label in hospitalized patients with bacterial pneumonia. Further, no distinction was made between community-acquired pneumonia and health care-associated pneumonia.

As the authors concluded, “Our study supports negative consequences of PCN allergy label in patients with bacterial pneumonia, including higher risk of hospitalization and death, and calls for public strategies, including history-taking and skin testing, and/or drug challenge, to actively address PCN allergy label to lessen the morbidity and mortality from pneumonia.”

Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.