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Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin

Kimberly G Blumenthal1,2,3, Na Lu4, Yuqing Zhang4,3

  • 1Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA 20114, USA kblumenthal1@partners.org.

BMJ (Clinical Research Ed.)
|June 29, 2018
PubMed
Abstract

Insights

Penicillin allergy is linked to higher risks of MRSA and C. difficile infections. This increased risk is primarily due to greater use of alternative antibiotics, highlighting the need to address penicillin allergy labels.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Public Health

Background:

  • Penicillin allergy is a common concern, often leading to the avoidance of beta-lactam antibiotics.
  • This avoidance can result in the prescription of alternative antibiotics, which may have different resistance profiles.
  • The impact of penicillin allergy on the development of specific resistant infections like MRSA and C. difficile requires further investigation.

Purpose of the Study:

  • To evaluate the association between a penicillin allergy diagnosis and the subsequent development of meticillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infections.
  • To determine the role of antibiotic prescribing patterns, specifically the use of beta-lactam and alternative antibiotics, in mediating this association.

Main Methods:

  • A population-based matched cohort study was conducted using UK general practice data from 1995 to 2015.
  • 301,399 adults without prior MRSA or C. difficile were included, with 64,141 having a penicillin allergy diagnosis.
  • Participants were matched based on age, sex, and study entry time, with follow-up for incident MRSA and C. difficile infections and antibiotic use.

Main Results:

  • Patients with a penicillin allergy diagnosis had a significantly increased risk of developing MRSA (aHR 1.69) and C. difficile (aHR 1.26).
  • Individuals with penicillin allergy showed substantially higher rates of macrolide, clindamycin, and fluoroquinolone use compared to controls.
  • The increased use of beta-lactam alternative antibiotics accounted for a significant portion of the elevated risk for both MRSA (55%) and C. difficile (35%).

Conclusions:

  • Documented penicillin allergy is associated with an increased risk of MRSA and C. difficile infections.
  • This increased risk is largely mediated by the increased prescription of alternative antibiotics.
  • Systematically reviewing and addressing penicillin allergy labels is a crucial public health strategy to mitigate the incidence of these resistant infections.

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