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The Incidence of Antimicrobial Allergies in Hospitalized Patients
Implications Regarding Prescribing Patterns and Emerging Bacterial Resistance
Collin E. Lee, RPh;
Teresa R. Zembower, MD;
Michael A. Fotis, RPh;
Michael J. Postelnick, RPh;
Paul A. Greenberger, MD;
Lance R. Peterson, MD;
Gary A. Noskin, MD
Arch Intern Med. 2000;160:2819-2822.
Background The development of antimicrobial guidelines is one way in which institutions attempt to control emerging resistance, but the real challenge falls on promoting and ensuring adherence to these guidelines. Investigating reasons for the prescribing of alternative antimicrobial agents outside of these guidelines is crucial for modifying practices that may adversely impact institutional antimicrobial goals.
Methods Retrospective cross-referencing of computerized pharmacy printouts and concurrent manual medical record review.
Results Approximately 25% (470/1893) of the patients requiring antimicrobial therapy reported an allergy to at least 1 antimicrobial agent. The most commonly reported antimicrobial allergy was penicillin (295/1893 [15.6%]). Eighty-five patients (18.1%) reported having an allergy to 2 or more antimicrobial agents. Only 4% (27/601) of the reported antimicrobial allergies contained documentation as to the nature of the specific allergic reactions, while a manual medical record review revealed that 32% (23/73) of the antimicrobial allergies contained documentation of the specific allergic reaction. Ninety-eight (39.7%) of 247 patients reporting an allergy only to penicillin and/or cephalosporin received vancomycin in comparison with 247 (17.4%) of 1423 patients without any antimicrobial allergies (P<.001). Similarly, 53 (21.5%) of 247 patients with reported penicillin and/or cephalosporin allergies received levofloxacin compared with 114 (8.0%) of 1423 patients without any antimicrobial allergy (P<.001).
Conclusion The incidence of penicillin allergy at our institution exceeds population averages. This finding, in combination with limited documentation of drug allergies, appears to lead to the prescribing of alternative antimicrobial agents that do not fit into institutional antimicrobial guidelines and, in some instances, may put the patient at risk for infection and/or colonization with resistant organisms. Use of these alternative agents may adversely impact the ability to manage emerging antimicrobial resistance.
From the Northwestern Prevention Epicenter (Ms Lee, Drs Zembower, Peterson, and Noskin, and Mr Postelnick) and Department of Pharmacy (Ms Lee and Messrs Fotis and Postelnick), Northwestern Memorial Hospital, and Divisions of Infectious Diseases (Drs Zembower, Peterson, and Noskin) and Allergy/Immunology (Dr Greenberger), Department of Medicine, and Division of Clinical Microbiology, Department of Pathology (Dr Peterson), Northwestern University Medical School, Chicago, Ill.
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