Antimicrobial anaphylaxis: the changing face of severe antimicrobial allergy
| Autor: | Ar Kar Aung, Jason A Trubiano, Brittany Stevenson, Robert Pickles, Melissa Young, Michaela Lucas, Andrew J. Stewardson, Victoria Hall, Eugene Athan, Allen C. Cheng, Katie Elliott, Micah Wong, Ashleigh J. Baird, Maitri Munsif |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty Allergy Databases Factual law.invention Drug Hypersensitivity Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine law Surveys and Questionnaires Internal medicine Epidemiology medicine Adverse Drug Reaction Reporting Systems Humans Pharmacology (medical) 030212 general & internal medicine Anaphylaxis Aged Retrospective Studies Pharmacology Inpatients business.industry Australia Retrospective cohort study Middle Aged medicine.disease Antimicrobial Intensive care unit Anti-Bacterial Agents Hospitalization Infectious Diseases 030228 respiratory system Female business Adverse drug reaction Follow-Up Studies Cohort study |
| Zdroj: | Journal of Antimicrobial Chemotherapy. |
| ISSN: | 1460-2091 0305-7453 |
| DOI: | 10.1093/jac/dkz422 |
| Popis: | Objectives The epidemiology, clinical characteristics and outcomes of antimicrobial-associated anaphylaxis remain ill-defined. We sought to examine antimicrobial anaphylaxis with regard to: (i) the frequency of implicated antimicrobials; (ii) attributable mortality; and (iii) referral for definitive allergy assessment. Methods This was conducted through a national retrospective multicentre cohort study at five Australian tertiary hospitals (January 2010 to December 2015). Cases of antimicrobial anaphylaxis were identified from ICD-10 coding and adverse drug reaction committee databases. Results There were 293 participants meeting the case definition of antimicrobial anaphylaxis and 310 antimicrobial anaphylaxis episodes. Of 336 implicated antimicrobials, aminopenicillins (62/336, 18.5%) and aminocephalosporins (57/336, 17%) were implicated most frequently. ICU admission occurred in 43/310 (13.9%) episodes; however, attributable mortality was low (3/310, 1%). The rate of anaphylaxis to IV antibiotics was 3.5 (95% CI = 2.9–4.3) per 100 000 DDDs and the rate of hospital-acquired anaphylaxis was 1.9 (95% CI = 2.1–3.3) per 100 000 occupied bed-days. We observed overall low rates of hospital discharge documentation (222/310, 71.6%) and follow-up by specialist allergy services (73/310, 23.5%), which may compromise medication safety and antimicrobial prescribing in future. Conclusions This study demonstrated that a high proportion of severe immediate hypersensitivity reactions presenting or acquired in Australian hospitals are secondary to aminopenicillins and aminocephalosporins. Overall rates of hospital-acquired anaphylaxis, predominantly secondary to cephalosporins, are low, and also associated with low inpatient mortality. |
| Databáze: | OpenAIRE |
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