ID WEEK 2016 POSTER ABSTRACTS 308. Impact of Allergy Status on Outcomes in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections Spenser January, PharmD1; Rachel M. Kenney, PharmD2; Michael Veve, PharmD3; Edward Zoratti, MD1; Marcus Zervos, MD4; Susan L. Davis, PharmD3; 1Henry Ford Hospital, Detroit, Michigan; 2Pharmacy, Henry Ford Hospital, Detroit, Michigan; 3 Wayne State University College of Pharmacy, Detroit, Michigan; 4Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan Session: 54. HAI: MSSA, MRSA, and other Gram-Positives Thursday, October 27, 2016: 12:30 PM Background. Beta-lactams (BL) are the antibiotics of choice for methicillin-susceptible Staphylococcus aureus bloodstream infections (MSSA BSI). Despite widespread BL allergy reporting, true BL allergies are uncommon. It is unclear whether a reported BL allergy adversely affects optimal treatment and outcome of MSSA BSI. Methods. Institutional Review Board-approved, retrospective matched cohort study of patients with MSSA BSI with and without a BL allergy from January 2014 to December 2015 matched 1:3 by time and severity (intensive care unit status). Data collected: patient, allergy, and infection characteristics, antibiotic use, outcomes. Primary endpoint: proportion of patients who received optimal therapy, defined as antistaphylococcal BL. Bivariate and multivariate regression were utilized to identify characteristics associated with receipt of optimal therapy. Results. Two hundred twelve patients were included: 53 with BL allergy and 159 without BL allergy. There were no significant differences in baseline or infection
characteristics. Among BL allergic patients: 26 (49%) had an immune mediated reaction, 8 (15%) had a reaction that was intolerance and not allergy, and 19 (36%) had an unspecified reaction. Of 53 allergic patients, desensitization occurred in one patient; allergy consults were completed for 13% of patients. Optimal antibiotics were given to 135 patients without a BL allergy and 37 patients with a BL allergy (85% versus 70%, P = 0.015). Nafcillin or cefazolin was the optimal antibiotic used in 95% of patients. Median time to optimal antibiotics was 29 hours for both groups (P = 0.64). No differences were found in clinical cure (79% versus 81%, P = 0.76) or mortality (19% versus 18%, P = 0.84). Infectious disease consults were more common among BL allergic (89% versus 75%, P = 0.04) and were associated with an increased usage of optimal antibiotics (68% versus 13%, P < 0.001), as seen in the table. Table:
Characteristics Associated With Optimal Antibiotics
Beta-lactam allergy ID consult Immunosuppressed
n, % Total Population
Unadjusted OR 95% CI
Adjusted OR 95% CI
53 (25) 167 (79) 25 (12)
0.41 (0.2–0.85) 4.4 (2.1–9.3) 2.9 (0.66–1.3)
0.3 (0.1–0.6) 6.1 (2.7–13.9) 2.9 (0.6–13.8)
Conclusion. Patients with a documented BL allergy were less likely to receive optimal antibiotics for MSSA BSI. Patient outcomes may be improved with routine use of infectious disease consult to optimize therapy in patients who report BL allergies. Disclosures. M. Zervos, Pfizer: Research Contractor, Research support. Cerexa: Research Contractor, Research support. Cubist: Research Contractor, Research support. Merck: Research Contractor, Research support. Tetraphase: Research Contractor, Research support. Melinta: Research Contractor, Research support. Paratek: Research Contractor, Research support. Rempex: Research Contractor, Research support. Cempra: Grant Investigator, Research support
Some abstract images in the OFID IDWeek 2016 Abstract Supplement may be unclear. In those instances, it is recommended that you use the IDWeek Interactive Program Planner to view the abstract and images. The Program Planner can be found here: https://idsa.confex.com/idsa/2016/webprogram/start.html. Open Forum Infectious Diseases 2016;1(S1):S1–285 © The Author 2016. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact
[email protected]. DOI: 10.1093/ofid/ofw172
Poster Abstracts
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OFID 2016:1 (Suppl 1)
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