A study of long-term care (LTC) facilities in Massachusetts found that residents with a documented penicillin allergy were 95% less likely to receive beta-lactam antibiotics, researchers reported yesterday in Antimicrobial Stewardship & Healthcare Epidemiology.
For the study, researchers from Tufts University and the Massachusetts Department of Public Health analyzed data on antibiotic prescriptions and penicillin allergies at 20 LTC facilities across the state. The aim of the study was to measure the impact of documented penicillin allergies on the prescribing patterns of beta-lactam antibiotics in LTC facilities, where an estimated 50% to 75% of residents receive at least on antibiotic annually. Previous research has shown that penicillin allergy labels are frequently inaccurate and can result in the selection of broader-spectrum antibiotics, which contribute to antimicrobial resistance and have an increased risk of side effects.
“Inaccurate penicillin allergy labeling poses a critical health threat in this vulnerable population because older individuals are more susceptible to mortality from multidrug-resistant infections and adverse effects from broad-spectrum antibiotics,” the study authors wrote.
Penicillin allergy delabeling efforts needed in LTCs
Among 2,345 LTC residents, 449 (19.1%) received an antibiotic, and 156 of the antibiotic recipients (34.7%) had a documented penicillin allergy. The primary indications for antibiotic prescriptions were urinary tract infections (UTIs) (45.4%), respiratory tract infections (RTIs) (29.2%), and skin and soft-tissue infections (SSTIs) (18.5%). Beta-lactams accounted for 45.5% of all antibiotic prescriptions.
Inaccurate penicillin allergy labeling poses a critical health threat in this vulnerable population because older individuals are more susceptible to mortality from multidrug-resistant infections and adverse effects from broad-spectrum antibiotics.
Multivariable regression analysis revealed that residents with a documented penicillin allergy were significantly less likely to be receiving beta-lactam antibiotics for all infections (adjusted odds ratio [aOR], 0.05; 95% confidence interval [CI], 0.03 to 0.09), UTIs (aOR, 0.03; 95% CI, 0.01 to 0.08), RTIs (aOR, 0.05; 95% CI, 0.02 to 0.13), and SSTIs (aOR, 0.11; 95% CI 0.03 to 0.38).
The authors say the findings underscore the need to improve penicillin allergy assessments and delabeling strategies in LTC settings.
