Abstract
Objective
To determine the impact of reported beta-lactam allergies on in-hospital mortality
and other clinical outcomes in patients who presented with severe sepsis or septic
shock.
Methods
This single-center, retrospective cohort study was performed at a 35-bed emergency
department in central Kentucky. Patients presenting with sepsis, aged 18 years or older, were identified between October 2016 and June 2017.
Results
438 patients with severe sepsis and/or septic shock were identified. Rates of the
combined endpoint of in-hospital mortality or transfer to hospice were similar in
patients with a beta-lactam allergy (7.2%) versus those with no reported beta-lactam
allergy (10.4%) (p = 0.41). Time to initiation of antibiotic therapy was slightly longer in the beta-lactam
allergic group (2.2 h) versus those with no reported beta-lactam allergy (2.15 h), but the difference was not statistically significant (p = 0.993). Patients were 20.9% more likely to receive an appropriate empiric antibiotic,
based off of retrospective culture review, if they did not report a beta-lactam allergy
(p = 0.009). This led to a delay in effective therapy of 1.59 h in the reported beta-lactam allergy arm (p = 0.037).
Conclusions
Adequate documentation of beta-lactam allergies is vital to ensure timely and appropriate
treatment in patients presenting with severe sepsis and septic shock. Choosing alternative
treatment options results in increased time to effective antibiotics, reduced likelihood
of covering cultures with first antibiotic, and increased total hospital and variable
direct cost.
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Article Info
Publication History
Published online: May 16, 2020
Accepted:
May 10,
2020
Received in revised form:
April 27,
2020
Received:
December 28,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
