A systematic review and meta-analysis found that beta-lactam allergy labels (BALs) are associated with increased rates of surgical-site infection and other adverse outcomes, researchers reported yesterday in The Lancet Infectious Diseases.
The review, led by researchers from the University of Peking, included 63 observational and interventional studies that compared clinical outcomes related to the presence or absence of a BAL.
While an estimated 10% to 15% of adults worldwide carry a BAL, the label is often unverified, and as many as 90% of people with a BAL may actually be beta-lactam tolerant. The concern is that patients with BALs may receive inappropriate treatment with alternative broad-spectrum antibiotics, which can result in unintended adverse effects.
Of the 63 studies reviewed, 60 were from high-income countries. The studies were conducted in the Americas (41), Europe (15), and the Western Pacific region (7).
Overall, BALs were associated with increased rates of surgical site infection (odds ration [OR], 1.60; 95% confidence interval [CI], 1.27 to 2.01), rates of infection or colonization with both multidrug-resistant organisms (MDROs) (OR, 1.42; 95% CI, 1.22 to 1.64) and Clostridioides difficile (OR, 1.26; 95% CI, 1.16 to 1.37), and length of hospital stay (standardized mean difference, 0.06 days; 95% CI, 0.05 to 0.08), although the study authors say the latter finding may not be clinically meaningful.
BALs were also associated with death at or after 180 days but not with overall, in-hospital, or 30-day mortality.
Countries should prioritize management of antibiotic allergy labels
“Given the high prevalence and potential negative consequences of BALs, it is imperative for all countries to prioritise and make proactive efforts to manage antibiotic allergy labels via their national antimicrobial stewardship regulations and clinical guidelines,” the authors wrote. “Such efforts include avoiding unnecessary new labels and systematic removal of existing inaccurate labels documented in people’s health records (ie, delabelling) by verifying allergy risks and categorising patients’ risk levels.”
The authors add that while the review is the most comprehensive evaluation of the global burden of BALs to date, further research is needed in low-income countries and children.
