{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:42:22Z","timestamp":1791405742437,"version":"4.3.3"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>\u03b2-lactam (BL) allergies are the most common drug allergy worldwide, but most are reported in error. BL allergies are also well-established risk factors for adverse drug events and antibiotic-resistant infections during inpatient health care encounters, but the understanding of the long-term outcomes of patients with BL allergies remains limited.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the long-term clinical outcomes of patients with BL allergies.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This longitudinal retrospective cohort study was conducted at a single regional health care system in western Pennsylvania. Electronic health records were analyzed for patients who had an index encounter with a diagnosis of sepsis, pneumonia, or urinary tract infection between 2007 and 2008. Patients were followed-up until death or the end of 2018. Data analysis was performed from January 2022 to January 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>The presence of any BL class antibiotic in the allergy section of a patient\u2019s electronic health record, evaluated at the earliest occurring observed health care encounter.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was all-cause mortality, derived from the Social Security Death Index. Secondary outcomes were defined using laboratory and microbiology results and included infection with methicillin-resistant Staphylococcus aureus<\/jats:italic> (MRSA), Clostridium difficile<\/jats:italic>, or vancomycin-resistant Enterococcus<\/jats:italic> (VRE) and severity and occurrence of acute kidney injury (AKI). Generalized estimating equations with a patient-level panel variable and time exposure offset were used to evaluate the odds of occurrence of each outcome between allergy groups.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 20\u202f092 patients (mean [SD] age, 62.9 [19.7] years; 12\u202f231 female [60.9%]), of whom 4211 (21.0%) had BL documented allergy and 15\u202f881 (79.0%) did not, met the inclusion criteria. A total of 3513 patients (17.5%) were Black, 15\u202f358 (76.4%) were White, and 1221 (6.0%) were another race. Using generalized estimating equations, documented BL allergies were not significantly associated with the odds of mortality (odds ratio [OR], 1.02; 95% CI, 0.96-1.09). BL allergies were associated with increased odds of MRSA infection (OR, 1.44; 95% CI, 1.36-1.53), VRE infection (OR, 1.18; 95% CI, 1.05-1.32), and the pooled rate of the 3 evaluated antibiotic-resistant infections (OR, 1.33; 95% CI, 1.30-1.36) but were not associated with C difficile<\/jats:italic> infection (OR, 1.04; 95% CI, 0.94-1.16), stage 2 and 3 AKI (OR, 1.02; 95% CI, 0.96-1.10), or stage 3 AKI (OR, 1.06; 95% CI, 0.98-1.14).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Documented BL allergies were not associated with the long-term odds of mortality but were associated with antibiotic-resistant infections. Health systems should emphasize accurate allergy documentation and reduce unnecessary BL avoidance.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.12313","type":"journal-article","created":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T15:31:50Z","timestamp":1715959910000},"page":"e2412313","source":"Crossref","is-referenced-by-count":11,"title":["Long-Term Outcomes Associated With \u03b2-Lactam Allergies"],"prefix":"10.1001","volume":"7","author":[{"given":"Matthew P.","family":"Gray","sequence":"first","affiliation":[{"name":"Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Kellum","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, 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