A systematic review and meta-analysis found that beta-lactam allergy labels (BALs) are associated with increased rates of surgical-site infection and other adverse outcomes, researchers reported yesterday in The Lancet Infectious Diseases.

The review, led by researchers from the University of Peking, included 63 observational and interventional studies that compared clinical outcomes related to the presence or absence of a BAL. 

While an estimated 10% to 15% of adults worldwide carry a BAL, the label is often unverified, and as many as 90% of people with a BAL may actually be beta-lactam tolerant. The concern is that patients with BALs may receive inappropriate treatment with alternative broad-spectrum antibiotics, which can result in unintended adverse effects.

Of the 63 studies reviewed, 60 were from high-income countries. The studies were conducted in the Americas (41), Europe (15), and the Western Pacific region (7). 

Overall, BALs were associated with increased rates of surgical site infection (odds ration [OR], 1.60; 95% confidence interval [CI], 1.27 to 2.01), rates of infection or colonization with both multidrug-resistant organisms (MDROs) (OR, 1.42; 95% CI, 1.22 to 1.64) and Clostridioides difficile (OR, 1.26; 95% CI,  1.16 to 1.37), and length of hospital stay (standardized mean difference, 0.06 days; 95% CI, 0.05 to 0.08), although the study authors say the latter finding may not be clinically meaningful. 

BALs were also associated with death at or after 180 days but not with overall, in-hospital, or 30-day mortality.

Countries should prioritize management of antibiotic allergy labels

"Given the high prevalence and potential negative consequences of BALs, it is imperative for all countries to prioritise and make proactive efforts to manage antibiotic allergy labels via their national antimicrobial stewardship regulations and clinical guidelines," the authors wrote. "Such efforts include avoiding unnecessary new labels and systematic removal of existing inaccurate labels documented in people's health records (ie, delabelling) by verifying allergy risks and categorising patients' risk levels."

The authors add that while the review is the most comprehensive evaluation of the global burden of BALs to date, further research is needed in low-income countries and children.

Three African nations—Angola, Nigeria, and Somalia—confirmed circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, according to a weekly update from the Global Polio Eradication Initiative (GPEI).

Angola and Nigeria each reported one cVDPV2 case. The patient in Angola, who is from Benguela, had an onset of paralysis on December 12, 2024, raising the country's case total for 2024 to eight. The case in Nigeria is in Jigawa state and involved paralysis onset on January 23, raising the country's 2025 cVDPV2 case count to seven. Nigeria confirmed 98 cases last year.

Somalia confirmed four new cases, all in Bari province. Paralysis symptoms began in December 2024 for all of the patients, bringing the 2024 cVDPV2 total in the country to seven.

Recap of WHO SAGE meeting

The GPEI also provided highlights of last week's meeting of the World Health Organization's Strategic Advisory Group of Experts (SAGE) on Immunization.

The GPEI said, "SAGE expressed concern that despite the increase in wild poliovirus in the endemic areas [Afghanistan and Pakistan], there are no visible efforts towards transformative change in the eradication strategy; expressed concern at circulating variant polioviruses (cVDPVs) and their expansion into new areas, including in European countries; and stressed the need for increased efforts to improve routine immunization and reach zero-dose children."

SAGE reiterated its support for safe sunsetting of the bivalent (two-strain) oral polio vaccine and agreed with already established plans for pre-cessation vaccination campaigns.

The GPEI also noted that a polio vaccination in Gaza begun last month has reached more than 600,000 children under the age of 10 years.