Original Research

Prevalence of Antibiotic Allergy at a Spinal Cord Injury Center

Fed Pract. 2023 May;40(5):142-145 | doi:10.12788/fp.0378

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Background: Infectious diseases are the most common reason for rehospitalization in patients with spinal cord injury (SCI). Persons with SCI are at high risk for antibiotic overuse and hospital-acquired infection due to chronic bacteriuria, frequent health care exposure, implanted medical devices, and other factors. We aimed to record the percentage of subjects from the local SCI registry with an antibiotic allergy, the most common antibiotic classes responsible for the allergy, and allergic reactions.

Methods: We conducted a retrospective study at the James A. Haley Veterans’ Hospital in Tampa, Florida, of patients in the SCI registry between October 1, 2015, and September 30, 2017. We collected patient demographics and SCI descriptors. The outcomes included antibiotic allergy and adverse drug reactions.

Results: Of 1866 patients, 1659 met inclusion criteria; 29.8% of the subjects had a recorded allergy to antibiotics. Penicillin (13.1%), sulfa drugs (9.6%), and fluoroquinolone (4.5%) were the most common allergens. However, only 11.9% of patients with a penicillin allergy had severe reactions.

Conclusions: Almost 30% of patients with SCI had a recorded allergy to an antibiotic. There are opportunities to examine whether approaches to confirm true reactions, such as skin testing, would help mitigate unnecessary avoidance of certain antibiotic classes due to mild adverse effects, rather than a true allergy, in the SCI population. Differentiating true allergy is the only clear way to deter unnecessary avoidance of first-line therapies for antibiotic treatment and avoid promotion of antibiotic resistance.

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References

1. National Spinal Cord Injury Statistical Center. Spinal Cord Injury Model Systems. 2016 Annual Report –Complete Public Version. University of Alabama at Birmingham. Accessed March 20, 2023. https://www.nscisc.uab.edu/Public/2016%20Annual%20Report%20-%20Complete%20Public%20Version.pdf

2. Macy E, Richter PK, Falkoff R, Zeiger R. Skin testing with penicilloate and penilloate prepared by an improved method: amoxicillin oral challenge in patients with negative skin test responses to penicillin reagents. J Allergy Clin Immunol. 1997;100(5):586-591. doi:10.1016/s0091-6749(97)70159-3 3. Dhopeshwarkar N, Sheikh A, Doan R, et al. Drug-induced anaphylaxis documented in electronic health records. J Allergy Clin Immunol Pract. 2019;7(1):103-111. doi:10.1016/j.jaip.2018.06.010

4. Evans CT, LaVela SL, Weaver FM, et al. Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder. Infect Control Hosp Epidemiol. 2008;29(3):234-242. doi:10.1086/527509

5. Evans CT, Jump RL, Krein SL, et al. Setting a research agenda in prevention of healthcare-associated infections (HAIs) and multidrug-resistant organisms (MDROs) outside of acute care settings. Infect Control Hosp Epidemiol. 2018;39(2):210-213. doi:10.1017/ice.2017.291

6. Blumenthal KG, Peter JG, Trubiano JA, Phllips EJ. Antibiotic allergy. Lancet. 2019;393(10167):183-198. doi:10.1016/S0140-6736(18)32218-9 7. Evans CT, Fitzpatrick MA, Jones MM, et al. Prevalence and factors associated with multidrug-resistant gram-negative organisms in patients with spinal cord injury. Infect Control Hosp Epidemiol. 2017;38(12):1464-1471. doi:10.1017/ice.2017.238 8. Macy E, Poon KYT. Self-reported antibiotic allergy incidence and prevalence: age and sex effects. Am J Med. 2009;122(8):778.e1-778.e7. doi:10.1016/j.amjmed.2009.01.034

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Infectious diseases are the most common reason for rehospitalization among patients with spinal cord injuries (SCI), regardless of the number of years postinjury.¹ The appropriate use and selection of antibiotics for properly diagnosed infectious diseases is especially important for this population. This principle helps to avoid the development of drug-resistant organisms and reduces the risk of recurrent infections, aligning with antibiotic stewardship.

Antibiotics are the most common class of drug allergies in the general population, and penicillin is the most frequently reported allergen (up to 10%).² Prescription drug–induced anaphylaxis is severe and life threatening with a reported frequency of 1.1%. Penicillin and sulfonamide (46 and 15 per 10,000 patients, respectively) are the most common allergens.³ Although there is a significant difference between an adverse drug reaction (ADR) and true hypersensitivity, once documented in the electronic health record (EHR) as an allergy, this information deters use of the listed drugs.

Genitourinary, skin, and respiratory diseases are the leading causes for rehospitalization in patients with SCI.¹ A large proportion of these are infectious in etiology and require antibiotic treatment. In fact, persons with SCI are at high risk for antibiotic overuse and hospital-acquired infection due to chronic bacteriuria, frequent health care exposure, implanted medical devices, and other factors.⁴ Concurrently, there is a crisis of antibiotic-resistant bacteria proliferation, described asa threat to patient safety and public health.^5,6 Its severity is illustrated by the report that 38% of the cultures from patients with spinal cord injury are multidrug resistant gram-negative organisms.⁷

The SCI center at James A. Haley Veterans’ Hospital (JAHVH) in Tampa, Florida, serves a high concentration of active-duty military members and veterans with SCI. A study that reviews the exact frequency of antibiotic drug allergies listed on the EHR would be a key first step to identify the magnitude of this issue. The results could guide investigation into differentiating true allergies from ADRs, thereby widening the options for potentially life-saving antibiotic treatment.

Prevalence of Antibiotic Allergy at a Spinal Cord Injury Center

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