Abstract：
OBJECTIVE: Penicillin allergy is the most common drug allergy among hospitalized patients. Traditionally, aztreonam is recommended for patients labeled with penicillin allergy (PLWPA) in our institutional empirical antibiotic guidelines. Due to a global aztreonam shortage in December 2022, the antimicrobial stewardship unit recommended ceftazidime as a substitute. There is a paucity of real-world data on the safety profile of ceftazidime in PLWPA. Hence, we evaluated tolerability outcomes of ceftazidime use in PLWPA.
METHODS: This retrospective cohort study compared PLWPA in Singapore General Hospital who received aztreonam (October 2022-December 2022) or ceftazidime (December 2022-February 2023). Patients were stratified according to their risk of allergic reaction (AR) based on history of penicillin allergy. The severity of AR was based on the Delphi study grading system. The primary outcome was development of AR after initiation of aztreonam or ceftazidime. The secondary tolerability outcomes include hepatotoxicity and neurotoxicity.
RESULTS: There were 168 patients in the study; 69 were men (41.1%) and the median age was 69 years (interquartile range: 59-76 years). Incidence of AR was statistically similar in both arms: 1 of 102 patients (0.98%) in the aztreonam arm vs 2 of 66 patients (3.03%) in the ceftazidime arm (P = 0.33). The patient in the aztreonam arm was deemed at medium risk of having an AR and developed localized rashes (grade 1). Both patients in the ceftazidime arm were deemed at high risk of AR and developed localized skin reaction (grade 1). Hepatotoxicity was observed in 1 patient prescribed aztreonam. No patients in the ceftazidime arm developed adverse events.
CONCLUSIONS: Ceftazidime appears to be better tolerated and cheaper compared with aztreonam in PLWPA, and serves as an antimicrobial stewardship strategy to conserve broader-spectrum antibiotics use.
METHODS: This retrospective cohort study compared PLWPA in Singapore General Hospital who received aztreonam (October 2022-December 2022) or ceftazidime (December 2022-February 2023). Patients were stratified according to their risk of allergic reaction (AR) based on history of penicillin allergy. The severity of AR was based on the Delphi study grading system. The primary outcome was development of AR after initiation of aztreonam or ceftazidime. The secondary tolerability outcomes include hepatotoxicity and neurotoxicity.
RESULTS: There were 168 patients in the study; 69 were men (41.1%) and the median age was 69 years (interquartile range: 59-76 years). Incidence of AR was statistically similar in both arms: 1 of 102 patients (0.98%) in the aztreonam arm vs 2 of 66 patients (3.03%) in the ceftazidime arm (P = 0.33). The patient in the aztreonam arm was deemed at medium risk of having an AR and developed localized rashes (grade 1). Both patients in the ceftazidime arm were deemed at high risk of AR and developed localized skin reaction (grade 1). Hepatotoxicity was observed in 1 patient prescribed aztreonam. No patients in the ceftazidime arm developed adverse events.
CONCLUSIONS: Ceftazidime appears to be better tolerated and cheaper compared with aztreonam in PLWPA, and serves as an antimicrobial stewardship strategy to conserve broader-spectrum antibiotics use.
摘要：
目的：青霉素过敏是住院患者中最常见的药物过敏。传统上,在我们的机构经验性抗生素指南中,氨曲南被推荐用于标记有青霉素过敏(PLWPA)的患者.由于2022年12月全球氨曲南短缺，抗菌药物管理部门推荐头孢他啶作为替代品。关于头孢他啶在PLWPA中的安全性的实际数据很少。因此，我们评估了头孢他啶用于PLWPA的耐受性结果.
方法：这项回顾性队列研究比较了新加坡总医院接受氨曲南（2022年10月至2022年12月）或头孢他啶（2022年12月至2023年2月）的PLWPA。根据青霉素过敏史，根据患者的过敏反应（AR）风险对患者进行分层。AR的严重程度基于Delphi研究分级系统。主要结果是开始使用氨曲南或头孢他啶后发生AR。继发性耐受性结果包括肝毒性和神经毒性。
结果：研究中有168例患者；69例为男性（41.1%），中位年龄为69岁（四分位距：59-76岁）。两组的AR发生率在统计学上相似：氨曲南组102例患者中有1例（0.98％），头孢他啶组66例患者中有2例（3.03％）（P=0.33）。氨曲南组中的患者被认为处于患有AR的中等风险并且出现局部皮疹(1级)。头孢他啶臂中的两名患者被认为处于AR的高风险并且发生局部皮肤反应(1级)。在1例服用氨曲南的患者中观察到肝毒性。头孢他啶组中没有患者出现不良事件。
结论：头孢他啶在PLWPA中与氨曲南相比似乎具有更好的耐受性和更便宜，并作为抗菌药物管理策略，以节省广谱抗生素的使用。
方法：这项回顾性队列研究比较了新加坡总医院接受氨曲南（2022年10月至2022年12月）或头孢他啶（2022年12月至2023年2月）的PLWPA。根据青霉素过敏史，根据患者的过敏反应（AR）风险对患者进行分层。AR的严重程度基于Delphi研究分级系统。主要结果是开始使用氨曲南或头孢他啶后发生AR。继发性耐受性结果包括肝毒性和神经毒性。
结果：研究中有168例患者；69例为男性（41.1%），中位年龄为69岁（四分位距：59-76岁）。两组的AR发生率在统计学上相似：氨曲南组102例患者中有1例（0.98％），头孢他啶组66例患者中有2例（3.03％）（P=0.33）。氨曲南组中的患者被认为处于患有AR的中等风险并且出现局部皮疹(1级)。头孢他啶臂中的两名患者被认为处于AR的高风险并且发生局部皮肤反应(1级)。在1例服用氨曲南的患者中观察到肝毒性。头孢他啶组中没有患者出现不良事件。
结论：头孢他啶在PLWPA中与氨曲南相比似乎具有更好的耐受性和更便宜，并作为抗菌药物管理策略，以节省广谱抗生素的使用。
