Prevalence of Antibiotic Allergy at a Spinal Cord Injury Center

Infectious diseases are the most common reason for rehospitalization in patients with spinal cord injury (SCI). Persons with SCI are at high risk for antibiotic over-use and hospital-acquired infection due to chronic bacteriuria, frequent health care exposure, implanted medical devices, and other factors. We aimed to record the percentage of subjects from the local SCI registry with an antibiotic allergy, the most common antibiotic classes responsible for the allergy, and allergic reactions.

We conducted a retrospective study at the James A. Haley Veterans' Hospital in Tampa, Florida, of patients in the SCI registry between October 1, 2015, and September 30, 2017. We collected patient demographics and SCI descriptors. The outcomes included antibiotic allergy and adverse drug reactions.

Of 1866 patients, 1659 met inclusion criteria; 29.8% of the subjects had a recorded allergy to antibiotics. Penicillin (13.1%), sulfa drugs (9.6%), and fluoroquinolone (4.5%) were the most common allergens. However, only 11.9% of patients with a penicillin allergy had severe reactions.

Almost 30% of patients with SCI had a recorded allergy to an antibiotic. There are opportunities to examine whether approaches to confirm true reactions, such as skin testing, would help mitigate unnecessary avoidance of certain antibiotic classes due to mild adverse effects, rather than a true allergy, in the SCI population. Differentiating true allergy is the only clear way to deter unnecessary avoidance of first-line therapies for antibiotic treatment and avoid promotion of antibiotic resistance.