Hospitalizations in Children with a Penicillin Allergy Label: An Assessment of Healthcare Impact

Abstract

Background: Beta-lactam allergy is overdiagnosed. Diagnosis of penicillin allergy has been associated with a greater use of hospital resources and an increased risk of antibiotic-resistant infections, although this issue remains poorly studied in children. We aimed to compare patient characteristics and use of hospital resources in hospitalized children with and without a record of penicillin allergy. Methods: We identified all hospitalizations in children labelled as being allergic to penicillin in a database containing all hospitalizations in Portuguese public hospitals between 2000 and 2014, and compared these with a similar number of age-, sex-, and main diagnosis-matched hospitalizations without a penicillin allergy label. Comparisons were made for length of hospital stay, comorbidities (Charlson Comorbidity Index), in-hospital mortality, and hospitalization costs. Results: We identified 1,718 hospitalizations corresponding to children labelled as penicillin-allergic. Compared with patients without such a label, these children had longer hospital stays (mean 5 vs. 4 days, p = 0.03) and a higher comorbidity index (mean 0.11 vs. 0.09, p < 0.001). Hospitalization costs were also higher (EUR 2,071 vs. 1,798), but the difference was not significant (p = 0.12). Conclusions: Hospitalizations of children labelled as allergic to penicillin are associated with longer hospital stays, more comorbidities, and a tendency towards higher hospitalization costs. An accurate diagnosis of penicillin allergy based on clinical history and confirmatory tests is therefore essential in all paediatric patients.

The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: A systematic review

“…Of the 20 studies examining LOS, 11 (55%) found that allergy-labeled patients had significantly longer LOS. 2,19,20,25,29,30,[36][37][38][39][40] Also, 8 studies found equivocal results and 1 found that allergy-labeled patients were hospitalized for shorter duration. 17,21,23,24,[31][32][33]41,42 Of 6 studies, 1 (17%) found that allergylabeled patients were more likely to be admitted to the ICU, but all other studies reported no difference (Table 3).…”

The impact of beta-lactam allergy labels on hospitalized children

“…16,17 In this study, patients with β-lactam allergy were more likely to receive broader-spectrum antibiotic therapy when compared to nonallergic patients, both in composite and individually. This difference in antibiotic exposure has been shown in most similar studies including a systematic review, [5][6][7][8]10,11,18 and it is generally hypothesized to be the unique driving factor behind many of the negative outcomes reported in patients with antibiotic allergies compared to controls. For example, vancomycin is known to be inferior in the definitive treatment of Staphylococcal bacteremia when compared to antistaphylococcal penicillins or firstgeneration cephalosporins.…”

“…8 Previous studies examining hospitalized cohorts of children report that pediatric patients labeled with penicillin allergies frequently receive broader-spectrum antibiotics and experience longer hospital stays with higher overall costs. 10,11 However, these studies have important limitations including relatively small sample sizes, inconsistent approaches to adjust for confounding variables that may differ between allergic and nonallergic controls, and none have been conducted in the United States.…”

Analysis of the Costs Associated With the Elective Evaluation of Patients Labelled as Allergic to Beta-Lactams or Nonsteroidal Antiinflamatory Agents

“…In this sense, Abrams et al (2016) proposed a diagnostic protocol for children who are labeled as allergic to beta-lactams and insisted on the importance of correctly labeling the allergy to beta-lactams in the pediatric population, given its low prevalence (Seitz et al, 2011;Abrams et al, 2016;Mill et al, 2016;Roduit, 2019). Sousa-Pinto et al (2018) identified 1,718 hospitalizations corresponding to children with suspected allergy to beta-lactams. These children had more extended days of hospitalization and a higher comorbidity rate.…”