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Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study.

ABSTRACT: To evaluate the relation between penicillin allergy and development of meticillin resistant Staphylococcus aureus (MRSA) and C difficile.Population based matched cohort study.United Kingdom general practice (1995-2015).301?399 adults without previous MRSA or C difficile enrolled in the Health Improvement Network database: 64?141 had a penicillin allergy and 237?258 comparators matched on age, sex, and study entry time.The primary outcome was risk of incident MRSA and C difficile. Secondary outcomes were use of ? lactam antibiotics and ? lactam alternative antibiotics.Among 64?141 adults with penicillin allergy and 237?258 matched comparators, 1365 developed MRSA (442 participants with penicillin allergy and 923 comparators) and 1688 developed C difficile (442 participants with penicillin allergy and 1246 comparators) during a mean 6.0 years of follow-up. Among patients with penicillin allergy the adjusted hazard ratio for MRSA was 1.69 (95% confidence interval 1.51 to 1.90) and for C difficile was 1.26 (1.12 to 1.40). The adjusted incidence rate ratios for antibiotic use among patients with penicillin allergy were 4.15 (95% confidence interval 4.12 to 4.17) for macrolides, 3.89 (3.66 to 4.12) for clindamycin, and 2.10 (2.08 to 2.13) for fluoroquinolones. Increased use of ? lactam alternative antibiotics accounted for 55% of the increased risk of MRSA and 35% of the increased risk of C difficile.Documented penicillin allergy was associated with an increased risk of MRSA and C difficile that was mediated by the increased use of ? lactam alternative antibiotics. Systematically addressing penicillin allergies may be an important public health strategy to reduce the incidence of MRSA and C difficile among patients with a penicillin allergy label.

SUBMITTER: Blumenthal KG

PROVIDER: S-EPMC6019853 | biostudies-other | 2018 Jun

REPOSITORIES: biostudies-other

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Risk of meticillin resistant <i>Staphylococcus aureus</i> and <i>Clostridium difficile</i> in patients with a documented penicillin allergy: population based matched cohort study.

Blumenthal Kimberly G KG Lu Na N Zhang Yuqing Y Li Yu Y Walensky Rochelle P RP Choi Hyon K HK

BMJ (Clinical research ed.) 20180627

<h4>Objective</h4>To evaluate the relation between penicillin allergy and development of meticillin resistant <i>Staphylococcus aureus</i> (MRSA) and <i>C difficile</i>.<h4>Design</h4>Population based matched cohort study.<h4>Setting</h4>United Kingdom general practice (1995-2015).<h4>Participants</h4>301 399 adults without previous MRSA or <i>C difficile</i> enrolled in the Health Improvement Network database: 64 141 had a penicillin allergy and 237 258 comparators matched on age, sex, and stud ...[more]

PMID: 29950489

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Project description:The role of general practitioners (GPs) as reservoir and potential source for Staphylococcus aureus (SA) transmission is unknown. Our primary objective was to evaluate the prevalence of SA and community-acquired methicillin resistant SA (CA-MRSA) carrier status (including spa typing) among GPs and their patients in Belgium. The secondary objective was to determine the association between SA/CA-MRSA carriage in patients and their characteristics, SA carriage in GPs, GP and practice characteristics.The Belgian GPs, who swabbed their patients in the APRES study (which assessed the prevalence of SA nasal carriage in nine European countries; November 2010 -June 2011), were asked to swab themselves as well (May-June 2011). GPs and their patients had to complete a questionnaire on factors related to SA carriage and transmission. SA isolation including CA-MRSA and spa typing was performed on the swabs.In eighteen practices 34 GPs swabbed patients of which 25 GPs provided personal swabs. The analysis was performed on 3008 patient records. Among GPs SA carriage (28%) was more prevalent than among their patients (19.2%), but CA-MRSA carriage was not present. SA was more prevalent among younger patients and those living with cattle. Spa typing SA and MRSA strains did not suggest correlation within practices or between patients and GPs, but chronic skin conditions of GPs and always handshaking patients by SA positive GPs were associated with more SA among patients, and hand washing after every patient contact with less SA among patients in practices with high antibiotic prescribing rates.No MRSA was found among GPs, although their SA carriership was higher compared to their patients'. Spa types did not cluster within practices, possibly due to difference in timing of swabbing. To minimise SA transmission to their patients GPs should consider taking appropriate care of their chronic skin diseases, antibiotic prescribing behaviour, handshaking and hand washing habits.

Dataset Information

Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study.

Publications

Risk of meticillin resistant <i>Staphylococcus aureus</i> and <i>Clostridium difficile</i> in patients with a documented penicillin allergy: population based matched cohort study.

Similar Datasets

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