Evidence map›Paper›PMID 30826801›Full record

ArticleBMJ open2019

Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts.

Cameron J Phillips, Mark Gilchrist, Fiona J Cooke, Bryony D Franklin, David A Enoch, Michael E Murphy, Reem Santos, Eimear T Brannigan, Alison H Holmes

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.5field-weighted citation impact, top 33% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 12 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 2 countries.

Cameron J PhillipsImperial College Healthcare NHS Trust, London, UK.ORCID 0000-0003-0801-3802
Mark GilchristImperial College Healthcare NHS Trust, London, UK.
Fiona J CookeClinical Microbiology and Public Health Laboratory, National Infection Service, Public Health England, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Bryony D FranklinNIHR, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
David A EnochClinical Microbiology and Public Health Laboratory, National Infection Service, Public Health England, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Michael E MurphyClinical Microbiology and Public Health Laboratory, National Infection Service, Public Health England, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Reem SantosPharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Eimear T BranniganImperial College Healthcare NHS Trust, London, UK.
Alison H HolmesImperial College Healthcare NHS Trust, London, UK.
Imperial College Healthcare NHS Trust · GBCambridge University Hospitals NHS Foundation Trust · GBUniversity of Cambridge · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context.

settingData were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017.

designCohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report.

participantsInpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs.

resultsA total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73) p<0.001). Guideline-adherence for CAP was higher if penicillin allergy (151 of 163; 92.6%) versus no allergy (582 of 810; 71.9%) (OR 0.20 (95% CI 0.10 to 0.37) p<0.001). There was no difference in adherence between those with and without penicillin allergy for UTI, HAP or SSTI treatment.

conclusionsA relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP, received more guideline adherent antibiotics than those without allergy. Future studies investigating the clinical impact of penicillin allergy should include data on adherence to antibiotic guidelines.

Indexed as

Guideline AdherenceAgedAged, 80 and overAnti-Bacterial AgentsCohort StudiesCommunity-Acquired InfectionsCross InfectionDocumentationDrug HypersensitivityFemaleHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisPenicillinsAnti-Bacterial AgentsPenicillinsdrug allergyguideline-adherencepenicillinprescribing

Identifiers

PMID30826801
PMCPMC6398633
OpenAlexW2918727878

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.