Penicillin Allergy and Superbugs

    NextPrevious

    Penicillin Allergy and Superbugs

     

    Penicillin allergy is a common finding in many patient charts.  Sometimes it can be difficult to figure out who, when and why this label was added to a medical record.  Sometimes patients themselves perpetuate the label, unwittingly reporting something a parent told them about a possible reaction as a child, or mistaking side effects for a reaction.  Either way, taking care of one patient with anaphylaxis is enough to strike fear into the heart of any prescriber.

     

    A true allergy can be a dangerous issue and should, of course, be taken seriously.  However, up to 95% of people who report an allergy to penicillin are not actually allergic when they undergo formal allergy testing.

     

    When patients for whom penicillin (or a member of the penicillin family) is the most appropriate choice report an allergy, providers are forced to make another selection.  This generally means moving to a broader spectrum antibiotic, which, unfortunately, puts patients at a higher risk for developing antibiotic resistant infections, like MRSA, and health care associated infections, like C. Diff.

     

    A matched cohort study of 11.1 million patients in the UK from June 2018 (see reference below) sought to compare the risk of MRSA and C. diff in patients with a documented penicillin allergy.  After adjusting for risk factors for both MRSA and C. diff, patients with a penicillin allergy were found to have a 69% increased risk of infection with MRSA, and a 26% increased risk of infection with C. diff.

     

    Less than 0.1% of patients who report a penicillin allergy receive formal testing.  As ED physicians, we can help by asking specific questions about reactions and updating charts, as well as providing patients with the allergy clinic contact info to find out for sure if their allergy is real.

     

    Reference:

    Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study.  BMJ. 2018 Jun 27;361:k2400. doi: 10.1136/bmj.k2400.

    https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.13168

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • What Is Clinical Informatics?

      If you loved the super sexy topic of cerumen impaction yesterday…Well, hold on to your socks, because today we will continue our rousing educational foray by tackling the riveting question: What is Clinical Informatics? ShallRead more

    • Cerumen Impaction: an Update.

      The last time www.sinaiem.org addressed the topic of cerumen (ear wax) impaction was in 2013. See this post: http://sinaiem.org/50yo-man-with-chest-pain-and-also-with-r-ear-pain/  If you’re like me, you likely believe that the world of cerumen impaction is a rather staticRead more

    • Cervical Artery Dissection

      Cervical artery dissection (CAD) accounts for 1-2% of all ischemic strokes but 10-25% of strokes in younger individuals.  CAD includes extracranial carotid and vertebral artery dissections.  A review of the literature suggests that there mayRead more

    • Opioid Substitution Therapy

      ED physicians need to be comfortable with the various modalities of opioid substitution therapy (OST) and their associated complications.  We are all familiar with the patient who has missed a daily dose of methadone onRead more

    • Use the HEART Score

      There are approximately 8 million ED visits annually in the United States for chest pain. 10%-20% go on to receive an acute coronary syndrome diagnosis. The goal of the ED physician is to differentiate betweenRead more

    • Permissive Hypotension

      Resist the urge to administer a large crystalloid bolus in hypotensive trauma patients. Doing so worsens coagulopathy and acidosis. This practice should be abandoned. Normotensive trauma patients need no fluid resuscitation. The practice of permissiveRead more

    • PE Risk after Induced Abortion

      It’s well known that the risk of venous thromboembolism is increased during pregnancy.  It is thought to be two-to-six times higher than the risk in non-pregnant women.  However, these risk estimates are based on pregnantRead more

    • Bag Mask Ventilation During Intubation

      A few days ago NEJM published the results of an investigation with profound implications for our specialty.  A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study theRead more

    NextPrevious