与β-乳酸过敏相关的长期结果
Matthew P Gray1, John A Kellum2, Levent Kirisci1
1Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
JAMA network open
|May 17, 2024
概括
β-乳 (BL) 过敏不会增加死亡风险,但与抗生素耐药性感染有关. 准确的过敏记录和减少BL避免对于医疗保健系统至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 临床药理学 临床药理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- β-乳酸 (BL) 过敏很常见,但往往被误诊,造成不良药物事件和抗生素耐药性的风险.
- 对BL过敏患者的长期健康结果的理解是有限的.
研究的目的:
- 为了评估长期的临床结果,包括死亡率和抗生素耐药性感染,在被记录的β-lactam过敏的患者.
主要方法:
- 一项纵向回顾性队列研究分析了2007-2008年间超过20,000名患有败血症,肺炎或尿路感染的患者的电子健康记录.
- 随访患者一直持续到2018年,结果包括全因死亡率,甲素耐药黄金葡萄球菌 (MRSA),困难菌,抗菌素耐药菌 (VRE) 和急性损伤 (AKI).
- 用通用估计方程来比较记录BL过敏和没有记录BL过敏的患者之间的结果.
主要成果:
- 记录的BL过敏与所有原因死亡率的增加没有显著关联 (OR,1.02).
- BL过敏与MRSA (OR, 1.44) 和VRE (OR, 1.18) 感染的几率更高,以及结合抗生素耐药性感染 (OR, 1.33).
- 在BL过敏和Clostridium difficile感染或急性损伤之间没有发现显著的关联.
结论:
- 有记录的β-乳酸过敏与长期死亡率无关,但与抗生素耐药性感染的风险增加有关.
- 医疗保健系统应优先考虑准确的过敏记录,并尽量避免不必要的β-乳糖抗生素.
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