270. Prevalence and Impact of β-Lactam Allergies at a Canadian Pediatric Center
Session: Poster Abstract Session: Pediatric Antimicrobial and Diagnostic Stewardship
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • De-LABeL - Retrospective Review Poster_updated.pdf (3.2 MB)
  • Background: Rational and appropriate use of antibiotics is a global priority since inappropriate or unnecessary use is associated with antibiotic resistance and patient morbidity. In adult patients, the presence of a β-lactam allergy label (BLA) often leads to the use of broader spectrum agents with more toxicity. Infections account for a majority of pediatric hospital admissions, and β-lactam antibiotics are often considered first-line therapy. There is limited evidence on the impact of BLA on prescribing practices in pediatrics.

    Objectives: The primary objective of this study was to determine the proportion of children with a reported BLA who received second-line antimicrobials (as determined by hospital empiric antibiotic guidelines). The secondary objective was to identify patient characteristics associated with receiving second-line antibiotics.

    Methods: A one-year retrospective cohort study was undertaken at the Hospital for Sick Children. We reviewed the characteristics and management of patients with a reported BLA who received antibiotics from January to December 2016.

    Results: Of the 16 224 admissions in 2016, 206 patients with a reported BLA received antibiotics. Among these patients, the median age was 7.9 years (IQR 4.0,12.8) and the majority of patients had at least one medical condition (n=120, 59.3%), including 27 children with complex medical or genetic conditions (13.1%). Penicillin (n=86, 41.8%) and amoxicillin (n=70, 33.9%) were the most commonly reported allergens. Non-severe rashes were the most commonly reported allergic reactions (n=158, 73.1%). Ninety four patients (46%; 95% CI (0.39,0.52) received second-line therapy. After adjusting for age and sex, the odds of receiving a second-line antibiotic were increased in patients with any underlying medical condition (OR = 2.45, 95% CI 1.32-4.56), had a reported allergic reaction that was deemed high-risk (i.e. anaphylaxis, respiratory or systemic symptoms, severe rashes) (OR = 2.61, 95% CI 1.11-6.11) or who received antibiotics for surgical prophylaxis (OR = 3.30, 95% CI 1.44-7.54).

    Conclusion: Almost half of pediatric patients with a reported BLA received a second-line antibiotic when compared to hospital empiric antibiotic guidelines. There is a need for a systematic approach to evaluating reported BLA in order to promote judicious prescribing habits.

    Jacqueline Wong, MD, FRCPC, FAAP1, Mariana Torres, MD2, Kathryn Timberlake, PharmD3, Adelle Atkinson, MD, FRCPC4 and Michelle Science, MD, MSc, FRCPC1, (1)Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada, (2)Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada, (3)Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada, (4)Allergy & Immunology, The Hospital for Sick Children, Toronto, ON, Canada

    Disclosures:

    J. Wong, None

    M. Torres, None

    K. Timberlake, None

    A. Atkinson, None

    M. Science, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.