The Journal of hospital infection · 2026
Clinical and economic impacts of reported penicillin allergy in upper-limb animal bite infections: A Two-year Retrospective Study.
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Reed Benedict, Eaton Daniel, Awad Laura, Halog Melanie, Cook Hannah, Mutengesa Ernest, Clegg Arthur, Lamb Lucy, Kew Alex, Woollard Alex
Аннотация
BACKGROUND: Reported, and often inaccurate, penicillin allergy labels affect up to 10% of patients. Substituting non-penicillin-based antibiotics for first line β-lactams may compromise infection control and increase healthcare costs. Animal bites to the upper limb carry a significant risk of infection, functional impairment, and prolonged hospital stay.
METHODS: A retrospective cohort study of 307 adult patients with upper limb animal bites to a UK tertiary plastic surgery unit was conducted between January 2023 and January 2025. Multivariable regression models were adjusted for age, delay in debridement, comorbidities, and anatomical location.
RESULTS: Among 307 patients, 11% received non-penicillin-based antibiotics. Admission length was increased significantly by each decade of age (+7.3%), by each day's delay in initial debridement (+7.9%) and by the use of non-penicillin-based antibiotics (+27%). The frequency of operative infection control in theatre was increased significantly by age (IRR = 1.04, 95% CI 1.01 - 1.06) and delay in initial debridement (IRR = 1.35, 95% CI 1.047 - 1.732). Patients treated with non-penicillin-based antibiotics were nearly three times as likely to need operative infection control (IRR = 2.80, 95% CI 1.16 - 6.77), were seven times more likely to require an escalation in their initial treatment plan (OR = 7.09, 95% CI 2.18 - 23.06) and were twice as costly to manage (£1,288 vs £547).
CONCLUSIONS: Reported penicillin allergy is a modifiable risk factor linked with prolonged admission, more frequent operative management, and higher healthcare costs after animal bites. Integrating point-of-care allergy verification may improve outcomes and reduce economic burden within healthcare systems.
METHODS: A retrospective cohort study of 307 adult patients with upper limb animal bites to a UK tertiary plastic surgery unit was conducted between January 2023 and January 2025. Multivariable regression models were adjusted for age, delay in debridement, comorbidities, and anatomical location.
RESULTS: Among 307 patients, 11% received non-penicillin-based antibiotics. Admission length was increased significantly by each decade of age (+7.3%), by each day's delay in initial debridement (+7.9%) and by the use of non-penicillin-based antibiotics (+27%). The frequency of operative infection control in theatre was increased significantly by age (IRR = 1.04, 95% CI 1.01 - 1.06) and delay in initial debridement (IRR = 1.35, 95% CI 1.047 - 1.732). Patients treated with non-penicillin-based antibiotics were nearly three times as likely to need operative infection control (IRR = 2.80, 95% CI 1.16 - 6.77), were seven times more likely to require an escalation in their initial treatment plan (OR = 7.09, 95% CI 2.18 - 23.06) and were twice as costly to manage (£1,288 vs £547).
CONCLUSIONS: Reported penicillin allergy is a modifiable risk factor linked with prolonged admission, more frequent operative management, and higher healthcare costs after animal bites. Integrating point-of-care allergy verification may improve outcomes and reduce economic burden within healthcare systems.