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. 2018 Mar 7;71(1):29–35.

Table 1.

Summary of Studies Included in a Systematic Review of Antimicrobial Allergy Labelling

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Reference Study Objective(s) Study Design Country and Setting Population and Sample Size Outcome Type Reported
Charneski et al. 20118 To determine the impact of an antimicrobial allergy label in the medical record on clinical outcomes in hospitalized patients Retrospective cohort study United States: urban academic teaching hospital; nonsurgical patient care ward Age ≥ 20 years, received at least 1 antimicrobial prescription (n = 11 872) Clinical

  • Length of stay

  • ICU admission rate

  • Death

  • Readmission within 4 weeks of discharge

Prescribing

  • Received > 1 antimicrobial
Lutomski et al. 200814 To determine the frequency with which reported antibiotic allergies alter drug selection and to assess the validity of these allergies Retrospective cohort study United States: tertiary care teaching hospital; inpatients Age ≥ 18 years, at least 1 documented antibiotic allergy, and received antibiotic during hospital admission (n = 300) Prescribing

  • Antibacterial regimen

  • Most frequently selected alternative agents
MacLaughlin et al. 20009 To evaluate effects of reported β-lactam allergies on antibiotic selection and cost Retrospective cohort study United States: university- based family medicine clinic; ambulatory patients Patients of any age who received antibiotic for upper respiratory tract infection, otitis media, sinusitis (acute or chronic), and/or urinary tract infection (n = 660) Prescribing

  • Antibiotic selection (cephalosporin, macrolide)

Utilization

  • Antibiotic costs
Macy and Contreras 201410 To determine total hospital days, antibiotic exposure, and prevalence rates of Clostridium difficile, MRSA, and VRE in patients with and without penicillin allergy labels upon admission Retrospective matched-control cohort study United States: multiple hospitals (hospital type not specified); any admitted patient Age not specified (n = 154 746) Clinical

  • Length of stay

  • C. difficile prevalence

  • MRSA prevalence

  • VRE prevalence

Prescribing

  • Antibiotic selection (fluoroquinolones, ciprofloxacin, vancomycin, clindamycin, cephalosporin)

Utilization

  • Total hospital costs
Picard et al. 201313 To determine how physicians at a large Canadian tertiary care academic hospital without allergists on staff treat patients with a history of penicillin allergy Retrospective cohort study Canada: tertiary care academic hospital; ICU, coronary care unit, internal medicine wards Age not specified; penicillin allergy labelled (n = 172) Utilization

  • Cost (additional cost of alternative antibiotics in place of β-lactam standard of care)

Prescibing

  • Antibiotic selection (fluoroquinolones, vancomycin)
Sade et al. 200311 To examine the difference in cost and antibiotic usage between patients with and without penicillin allergy labels Retrospective matched-control cohort study Israel: tertiary level teaching hospital; internal medicine ward Age not specified; penicillin allergy labelled by physician (n = 236) Clinical

  • Death

  • Length of stay

Prescribing

  • Antibiotic selection (cephalosporin, macrolide, vancomycin)

  • No. of antibiotics used during treatment

  • Route of antibiotic administration

  • Frequency of drug administration

  • Duration of therapy

Utilization

  • Antibiotic costs during hospitalization

  • Antibiotic costs after hospitalization
Trubiano et al. 20155 To examine the rate of antimicrobial allergy labelling at a tertiary referral centre and impacts on antimicrobial usage and appropriateness Two inpatient antimicrobial prevalence surveys Australia: tertiary referral centre; inpatients Inclusion criteria not specified (n = 509) Prescribing

  • Antibiotic selection (cephalosporin, β-lactams)

  • Duration of antimicrobial therapy

  • Inappropriate antimicrobial prescribing

  • Route of antimicrobial administration

  • Antimicrobial exposure days
Trubiano et al. 201512 To (1) determine the prevalence of antimicrobial allergy labels in patients with cancer; (2) provide a description of reported antibiotic allergies; and (3) describe the impacts of an antimicrobial allergy label on antimicrobial choice, usage, and clinical outcomes Retrospective cohort study Australia: tertiary referral centre for cancer patients; oncology, hematology Age not specified; patients coded as having an infective diagnosis who received antimicrobial agent for treatment of infection, with inpatient admission > 24 h (n = 198) Clinical

  • 30-day or 60-day mortality

  • Length of stay

  • Overall readmissions

  • Readmissions with infectious disease diagnosis requiring antimicrobial therapy

Prescribing

  • Antibiotic selection (fluoroquinolone)

  • Antibiotics used per admission

  • Antibiotic duration

  • Concordance with first-line therapy

  • No. of antibiotics employed

ICU = intensive care unit, MRSA = multidrug-resistant Staphylococcus aureus, VRE = vancomycin-resistant Enterococcus.