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Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia

Nicholas A Turner1, Rebekah Moehring1, Christina Sarubbi2

  • 1Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.

Open Forum Infectious Diseases
|March 30, 2018
PubMed
Abstract

Insights

Reported penicillin allergy did not affect mortality in patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Beta-lactam antibiotics, not vancomycin, were linked to better survival outcomes, emphasizing accurate allergy assessment.

Area of Science:

  • Infectious Diseases
  • Clinical Pharmacology
  • Medical Microbiology

Background:

  • Penicillin allergy significantly influences antibiotic selection, particularly for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia.
  • Beta-lactam antibiotics offer superior efficacy over vancomycin for MSSA bacteremia treatment.
  • The study investigated the clinical impact of self-reported penicillin allergy on patient outcomes.

Purpose of the Study:

  • To determine if reported penicillin allergy affects mortality rates in patients with MSSA bacteremia.
  • To compare the effectiveness of vancomycin versus beta-lactams in MSSA bacteremia treatment based on allergy status.
  • To identify predictors of survival in MSSA bacteremia patients.

Main Methods:

  • Retrospective cohort study of adult patients with MSSA bacteremia.
  • Analysis of 30-day and 90-day mortality rates based on reported penicillin allergy.
  • Multivariable regression models to adjust for confounding factors and assess the impact of allergy on mortality.

Main Results:

  • Reported penicillin allergy did not significantly impact adjusted 30-day or 90-day mortality.
  • Patients with reported allergy were more likely to receive vancomycin, but many received cefazolin.
  • Non-allergic patients treated with vancomycin exhibited the highest mortality rates compared to those receiving beta-lactams.

Conclusions:

  • Self-reported penicillin allergy does not significantly alter mortality outcomes for MSSA bacteremia.
  • Vancomycin use in non-allergic patients with MSSA bacteremia is associated with higher mortality.
  • Appropriate beta-lactam administration, when tolerated, is the strongest predictor of survival, highlighting the need for accurate penicillin allergy classification.
Keywords:
bacteremiamethicillin-susceptible Staphylococcus aureuspenicillin allergy

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