Antibiotic Use in Patients With beta-Lactam Allergies and Pneumonia: Impact of an Antibiotic Side Chain-Based Cross-Reactivity Chart Combined With Enhanced Allergy Assessment

Background. beta-lactam antibiotics with dissimilar R-group side chains are associated with low cross-reactivity. Despite this, patients with beta-lactam allergies are often treated with non-beta-lactam alternative antibiotics. An institutional beta-lactam side chain-based cross-reactivity chart was developed and implemented to guide in antibiotic selection for patients with beta-lactam allergies. Methods. This single-center, retrospective cohort study analyzed the impact of the implementation of the cross-reactivity chart for patients with pneumonia. Study time periods were defined as January 2013 to October 2014 prior to implementation of the chart (historical cohort) and January 2017 to October 2018 (intervention cohort) following implementation. The primary outcome was the incidence of beta-lactam utilization between time periods. Propensity-weighted scoring and interrupted time-series analyses compared outcomes. Results. A total of 341 and 623 patient encounters were included in the historical and intervention cohorts, respectively. There was a significantly greater use of beta-lactams in the intervention cohort (70.4% vs 89.3%; P < .001) and decreased use of alternative therapy (58.1% vs 36%; P < .001). There was no difference in overall allergic reactions between cohorts (2.4% vs 1.6%; P = .738) or in reactions caused by beta-lactams (1.3% vs 0.9%; P = .703). Inpatient mortality increased (0% vs 6.4%; P < .001); however, no deaths were due to allergic reactions. Healthcare facility-onset Clostridioides difficile infections decreased between cohorts (1.2% vs 0.2%; P = .032). Conclusions. Implementation of a beta-lactam side chain-based cross-reactivity chart and enhanced allergy assessment was associated with increased use of beta-lactams in patients with pneumonia without increasing allergic reactions.