A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs

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• dc.contributor.author Rodríguez-Alarcón, Alicia
• dc.contributor.author Sanz de Mena, Manuela
• dc.contributor.author Alanti, Soukaina Sara
• dc.contributor.author Echeverría Esnal, Daniel
• dc.contributor.author Sorli Redó, M. Luisa
• dc.contributor.author Sendra, Elena
• dc.contributor.author Benítez-Cano, Adela
• dc.contributor.author Membrilla Fernández, Estela
• dc.contributor.author Cots, Francesc
• dc.contributor.author Güerri Fernández, Roberto
• dc.contributor.author Adalia Bartolomé, Ramón
• dc.contributor.author Horcajada Gallego, Juan Pablo
• dc.contributor.author Escolano Villén, Fernando
• dc.contributor.author Grau Cerrato, Santiago
• dc.contributor.author Gómez-Zorrilla, Silvia
• dc.date.accessioned 2024-10-15T06:20:16Z
• dc.date.available 2024-10-15T06:20:16Z
• dc.date.issued 2023
• dc.description.abstract Introduction: Penicillin allergy labels (PAL) are common in the hospital setting and are associated with worse clinical outcomes. Desensitization can be a useful strategy for allergic patients when alternative options are suboptimal or not available. The aim was to compare clinical outcomes of patients with PAL managed with antibiotic desensitization vs. those who received alternative non-beta-lactam antibiotic treatments. Methods: A retrospective 3:1 case-control study was performed between 2015-2022. Cases were adult PAL patients with infection who required antibiotic desensitization; controls were PAL patients with infection managed with an alternative antibiotic treatment. Cases and controls were adjusted for age, sex, infection source, and critical or non-critical medical services. Results: Fifty-six patients were included: 14 in the desensitization group, 42 in the control group. Compared to the control group, desensitized PAL patients had more comorbidities, with a higher Charlson index (7.4 vs. 5; p = 0.00) and more infections caused by multidrug-resistant (MDR) pathogens (57.1% vs. 28.6%; p = 0.05). Thirty-day mortality was 14.3% in the desensitized group, 28.6% in the control group (p = 0.24). Clinical cure occurred in 71.4% cases and 54.8% controls (p = 0.22). Four control patients selected for MDR strains after alternative treatment; selection of MDR strains did not occur in desensitized patients. Five controls had antibiotic-related adverse events, including Clostridioides difficile or nephrotoxicity. No antibiotic-related adverse events were found in the study group. In multivariate analysis, no differences between groups were observed for main variables. Conclusion: Desensitization was not associated with worse clinical outcomes, despite more severe patients in this group. Our study suggests that antibiotic desensitization may be a useful Antimicrobial Stewardship tool for the management of selected PAL patients.
• dc.format.mimetype application/pdf
• dc.identifier.citation Rodríguez-Alarcón A, Sanz de Mena M, Alanti SS, Echeverría-Esnal D, Sorli L, Sendra E, et al. A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs. Front Pharmacol. 2023 Nov 15;14:1260632. DOI: 10.3389/fphar.2023.1260632
• dc.identifier.doi http://dx.doi.org/10.3389/fphar.2023.1260632
• dc.identifier.issn 1663-9812
• dc.identifier.uri http://hdl.handle.net/10230/61402
• dc.language.iso eng
• dc.publisher Frontiers
• dc.relation.ispartof Front Pharmacol. 2023 Nov 15;14:1260632
• dc.rights © 2023 Rodríguez-Alarcón, Sanz de Mena, Alanti, Echeverría-Esnal, Sorli, Sendra, Benítez-Cano, Membrilla, Cots, Güerri-Fernández, Adalia, Horcajada, Escolano, Grau and Gómez-Zorrilla. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Allergy
• dc.subject.keyword Antibiotic desensitization
• dc.subject.keyword Antimicrobial stewardship programs
• dc.subject.keyword Beta-lactams
• dc.subject.keyword Hypersensitivity
• dc.subject.keyword Penicillins
• dc.title A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion