Infectious diseases are the most common reason for rehospitalization among patients with spinal cord injuries (SCI), regardless of the number of years postinjury.1 The appropriate use and selection of antibiotics for properly diagnosed infectious diseases is especially important for this population. This principle helps to avoid the development of drug-resistant organisms and reduces the risk of recurrent infections, aligning with antibiotic stewardship.
Antibiotics are the most common class of drug allergies in the general population, and penicillin is the most frequently reported allergen (up to 10%).2 Prescription drug–induced anaphylaxis is severe and life threatening with a reported frequency of 1.1%. Penicillin and sulfonamide (46 and 15 per 10,000 patients, respectively) are the most common allergens.3 Although there is a significant difference between an adverse drug reaction (ADR) and true hypersensitivity, once documented in the electronic health record (EHR) as an allergy, this information deters use of the listed drugs.
Genitourinary, skin, and respiratory diseases are the leading causes for rehospitalization in patients with SCI.1 A large proportion of these are infectious in etiology and require antibiotic treatment. In fact, persons with SCI are at high risk for antibiotic overuse and hospital-acquired infection due to chronic bacteriuria, frequent health care exposure, implanted medical devices, and other factors.4 Concurrently, there is a crisis of antibiotic-resistant bacteria proliferation, described as a threat to patient safety and public health.5,6 Its severity is illustrated by the report that 38% of the cultures from patients with spinal cord injury are multidrug resistant gram-negative organisms.7
The SCI center at James A. Haley Veterans’ Hospital (JAHVH) in Tampa, Florida, serves a high concentration of active-duty military members and veterans with SCI. A study that reviews the exact frequency of antibiotic drug allergies listed on the EHR would be a key first step to identify the magnitude of this issue. The results could guide investigation into differentiating true allergies from ADRs, thereby widening the options for potentially life-saving antibiotic treatment.