Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis
BackgroundTo date, several studies have demonstrated that erroneous labeling of Penicillin allergy (PAL) can significantly impact treatment options and result in adverse clinical outcomes, while other studies have reported no negative effects. Therefore, to systematically evaluate these effects and...
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Frontiers Media S.A.
2025-01-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1519522/full |
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| author | Shipeng Zhang Shipeng Zhang Tianyi Dong Jiawen Xian Jiawen Xian Xinyue Xiao Xinyue Xiao Jiaqing Yuan Jiaqing Yuan Tong Zeng Tong Zeng Kuan Deng Kuan Deng Rui Fu Hanyu Wang Hanyu Wang Yanjie Jiang Xueying Li Xueying Li |
| author_facet | Shipeng Zhang Shipeng Zhang Tianyi Dong Jiawen Xian Jiawen Xian Xinyue Xiao Xinyue Xiao Jiaqing Yuan Jiaqing Yuan Tong Zeng Tong Zeng Kuan Deng Kuan Deng Rui Fu Hanyu Wang Hanyu Wang Yanjie Jiang Xueying Li Xueying Li |
| author_sort | Shipeng Zhang |
| collection | DOAJ |
| description | BackgroundTo date, several studies have demonstrated that erroneous labeling of Penicillin allergy (PAL) can significantly impact treatment options and result in adverse clinical outcomes, while other studies have reported no negative effects. Therefore, to systematically evaluate these effects and investigate the association between adverse clinical outcomes and the Penicillin label, we conducted this meta-analysis.MethodSearches were conducted in the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to 13 July 2024. The search strategy utilized terms (“antibiotic allergy label,” “penicillin allergy label,” and “allergy label”) and (“death,” “readmission,” “adverse outcome,” and “clinical adverse outcome”). In the study selection process, the PICOS framework and stringent inclusion/exclusion criteria were applied. The quality of the initially included studies was independently assessed using the Newcastle-Ottawa Scale (NOS). Data from the included studies, including relative risk (RR) and 95% confidence intervals (CI), were extracted and analyzed using Stata 16.0. Sensitivity analyses were conducted to validate the results. Heterogeneity was assessed using the I2 and Cochrane Q tests, and publication bias was evaluated using Egger’s test and funnel plot analysis.ResultsA total of 497 relevant studies were identified through four databases. Following a thorough screening process, 11 studies encompassing 1,200,785 participants were ultimately included. The combined evidence suggests that penicillin allergy labeling is associated with increased mortality RR = 1.06 (95% CI 1.06–1.07, I2 = 0.00%), acute heart failure (RR = 1.19, 95% CI 1.09–1.30, τ2 = 0.00, I2 = 92.39%), ICU events (RR = 1.10, 95% CI 1.01–1.19, τ2 = 0.00, I2 = 57.09%), and mechanical ventilation events (RR = 1.16, 95% CI 1.09–1.24, τ2 = 0.00, I2 = 23.11%). Additionally, there was no significant association with readmissions (RR = 1.05, 95% CI 0.95–1.16, I2 = 0.00%).ConclusionOur findings indicate that penicillin allergy labels are associated with an increased risk of mortality in patients, as well as being linked to acute heart failure, heightened ICU requirements, and mechanical ventilation.Systematic Review Registration:PROSPERO, identifier CRD42024571535. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202457153. |
| format | Article |
| id | doaj-art-7662333489d24075b503b31119862eb0 |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-7662333489d24075b503b31119862eb02025-01-06T05:13:18ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-01-011510.3389/fphar.2024.15195221519522Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysisShipeng Zhang0Shipeng Zhang1Tianyi Dong2Jiawen Xian3Jiawen Xian4Xinyue Xiao5Xinyue Xiao6Jiaqing Yuan7Jiaqing Yuan8Tong Zeng9Tong Zeng10Kuan Deng11Kuan Deng12Rui Fu13Hanyu Wang14Hanyu Wang15Yanjie Jiang16Xueying Li17Xueying Li18Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaHospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaHospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaHospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaHospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaHospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaHospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaHospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaNanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, ChinaClinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaHospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaBackgroundTo date, several studies have demonstrated that erroneous labeling of Penicillin allergy (PAL) can significantly impact treatment options and result in adverse clinical outcomes, while other studies have reported no negative effects. Therefore, to systematically evaluate these effects and investigate the association between adverse clinical outcomes and the Penicillin label, we conducted this meta-analysis.MethodSearches were conducted in the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to 13 July 2024. The search strategy utilized terms (“antibiotic allergy label,” “penicillin allergy label,” and “allergy label”) and (“death,” “readmission,” “adverse outcome,” and “clinical adverse outcome”). In the study selection process, the PICOS framework and stringent inclusion/exclusion criteria were applied. The quality of the initially included studies was independently assessed using the Newcastle-Ottawa Scale (NOS). Data from the included studies, including relative risk (RR) and 95% confidence intervals (CI), were extracted and analyzed using Stata 16.0. Sensitivity analyses were conducted to validate the results. Heterogeneity was assessed using the I2 and Cochrane Q tests, and publication bias was evaluated using Egger’s test and funnel plot analysis.ResultsA total of 497 relevant studies were identified through four databases. Following a thorough screening process, 11 studies encompassing 1,200,785 participants were ultimately included. The combined evidence suggests that penicillin allergy labeling is associated with increased mortality RR = 1.06 (95% CI 1.06–1.07, I2 = 0.00%), acute heart failure (RR = 1.19, 95% CI 1.09–1.30, τ2 = 0.00, I2 = 92.39%), ICU events (RR = 1.10, 95% CI 1.01–1.19, τ2 = 0.00, I2 = 57.09%), and mechanical ventilation events (RR = 1.16, 95% CI 1.09–1.24, τ2 = 0.00, I2 = 23.11%). Additionally, there was no significant association with readmissions (RR = 1.05, 95% CI 0.95–1.16, I2 = 0.00%).ConclusionOur findings indicate that penicillin allergy labels are associated with an increased risk of mortality in patients, as well as being linked to acute heart failure, heightened ICU requirements, and mechanical ventilation.Systematic Review Registration:PROSPERO, identifier CRD42024571535. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202457153.https://www.frontiersin.org/articles/10.3389/fphar.2024.1519522/fullpenicillin allergy labelsadverse eventsmetarelative riskmortality |
| spellingShingle | Shipeng Zhang Shipeng Zhang Tianyi Dong Jiawen Xian Jiawen Xian Xinyue Xiao Xinyue Xiao Jiaqing Yuan Jiaqing Yuan Tong Zeng Tong Zeng Kuan Deng Kuan Deng Rui Fu Hanyu Wang Hanyu Wang Yanjie Jiang Xueying Li Xueying Li Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis Frontiers in Pharmacology penicillin allergy labels adverse events meta relative risk mortality |
| title | Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis |
| title_full | Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis |
| title_fullStr | Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis |
| title_full_unstemmed | Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis |
| title_short | Association between penicillin allergy labels and serious adverse events in hospitalized patients: a systematic review and meta-analysis |
| title_sort | association between penicillin allergy labels and serious adverse events in hospitalized patients a systematic review and meta analysis |
| topic | penicillin allergy labels adverse events meta relative risk mortality |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1519522/full |
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