Introduction of a penicillin allergy de-labelling program with direct oral challenge and its effects on utilization of beta-lactam antimicrobials: a multicenter retrospective parallel cohort study.
Allergy
Amoxicillin
Beta lactam
Delabel
Oral challenge
Penicillin
Stewardship
Journal
Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology
ISSN: 1710-1484
Titre abrégé: Allergy Asthma Clin Immunol
Pays: England
ID NLM: 101244313
Informations de publication
Date de publication:
05 Mar 2024
05 Mar 2024
Historique:
received:
03
08
2023
accepted:
31
01
2024
medline:
6
3
2024
pubmed:
6
3
2024
entrez:
5
3
2024
Statut:
epublish
Résumé
Self-reported penicillin allergy labels are common and often inaccurate after assessment. These labels can lead to reduced use of first-line beta-lactam antibiotics and worse outcomes. We measured the impact of a previously performed inpatient proactive systematic penicillin allergy de-labelling program on subsequent antibiotic use. This prior program included assessment, risk-stratification, and low risk direct oral amoxicillin challenge. We performed a retrospective comparison of parallel cohorts from two separate tertiary care hospital campuses in Ottawa, Canada across two penicillin de-labelling intervention periods across April 15th to April 30th, 2021, and February 15th to March 8th, 2022. Outcomes, including penicillin allergy labelling and antibiotic use, were collected for the index admission and the subsequent 6-month period. Descriptive statistics and multivariate regression analyses were performed. A total of 368 patients with penicillin allergy label were included across two campuses and study periods. 24 (13.8%) patients in the intervention groups had sustained penicillin allergy label removal at 30 days from admission vs. 3 (1.5%) in the non-intervention group (p < 0.001). In the 6-months following admission, beta-lactams were prescribed more frequently in the intervention groups vs. the non-intervention groups for all patients (28 [16.1%] vs.15 [7.7%], p = 0.04) and were prescribed more frequently amongst those who received at least one antibiotic (28/46 [60.9%] vs.15/40 [37.5%], p = 0.097). In a multivariate regression analysis, the intervention groups were found to be associated with an increased odds of beta-lactam prescribing in all patients (OR 2.49, 95%CI 1.29-5.02) and in those prescribed at least one antibiotic (OR 2.44, 95%CI 1.00-6.15). No drug-related adverse events were reported. Proactive penicillin allergy de-labelling for inpatients was associated with a reduction in penicillin allergy labels and increased utilization of beta-lactams in the subsequent 6-months.
Sections du résumé
BACKGROUND
BACKGROUND
Self-reported penicillin allergy labels are common and often inaccurate after assessment. These labels can lead to reduced use of first-line beta-lactam antibiotics and worse outcomes. We measured the impact of a previously performed inpatient proactive systematic penicillin allergy de-labelling program on subsequent antibiotic use. This prior program included assessment, risk-stratification, and low risk direct oral amoxicillin challenge.
METHODS
METHODS
We performed a retrospective comparison of parallel cohorts from two separate tertiary care hospital campuses in Ottawa, Canada across two penicillin de-labelling intervention periods across April 15th to April 30th, 2021, and February 15th to March 8th, 2022. Outcomes, including penicillin allergy labelling and antibiotic use, were collected for the index admission and the subsequent 6-month period. Descriptive statistics and multivariate regression analyses were performed.
RESULTS
RESULTS
A total of 368 patients with penicillin allergy label were included across two campuses and study periods. 24 (13.8%) patients in the intervention groups had sustained penicillin allergy label removal at 30 days from admission vs. 3 (1.5%) in the non-intervention group (p < 0.001). In the 6-months following admission, beta-lactams were prescribed more frequently in the intervention groups vs. the non-intervention groups for all patients (28 [16.1%] vs.15 [7.7%], p = 0.04) and were prescribed more frequently amongst those who received at least one antibiotic (28/46 [60.9%] vs.15/40 [37.5%], p = 0.097). In a multivariate regression analysis, the intervention groups were found to be associated with an increased odds of beta-lactam prescribing in all patients (OR 2.49, 95%CI 1.29-5.02) and in those prescribed at least one antibiotic (OR 2.44, 95%CI 1.00-6.15). No drug-related adverse events were reported.
CONCLUSIONS
CONCLUSIONS
Proactive penicillin allergy de-labelling for inpatients was associated with a reduction in penicillin allergy labels and increased utilization of beta-lactams in the subsequent 6-months.
Identifiants
pubmed: 38444037
doi: 10.1186/s13223-024-00877-9
pii: 10.1186/s13223-024-00877-9
doi:
Types de publication
Journal Article
Langues
eng
Pagination
20Informations de copyright
© 2024. The Author(s).
Références
Khan DA, Banerji A, Blumenthal KG, Phillips EJ, Solensky R, White AA, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Ledford D, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wallace D, Wang J; Chief Editor(s); Khan DA, Golden DBK, Shaker M, Stukus DR; Workgroup Contributors; Khan DA, Banerji A, Blumenthal KG, Phillips EJ, Solensky R, White AA; Joint Task Force on Practice Parameters Reviewers; Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Ledford D, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wallace D, Wang J. Drug allergy: a 2022 practice parameter update. J Allergy Clin Immunol. 2022;150(6):1333–1393. doi: https://doi.org/10.1016/j.jaci.2022.08.028 .
Sacco KA, Bates A, Brigham TJ, Imam JS, Burton MC. Clinical outcomes following inpatient penicillin allergy testing: a systematic review and meta-analysis. Allergy. 2017;72(9):1288–96. https://doi.org/10.1111/all.13168 .
doi: 10.1111/all.13168
pubmed: 28370003
Trubiano JA, Thursky KA, Stewardson AJ, Urbancic K, Worth LJ, Jackson C, Stevenson W, Sutherland M, Slavin MA, Grayson ML, Phillips EJ. Impact of an integrated antibiotic allergy testing program on antimicrobial stewardship: a multicenter evaluation. Clin Infect Dis. 2017;65(1):166–74.
doi: 10.1093/cid/cix244
pubmed: 28520865
pmcid: 5849110
Lee CE, Zembower TR, Fotis MA, Postelnick MJ, Greenberger PA, Peterson LR, et al. The incidence of antimicrobial allergies in hospitalized patients: implication regarding prescribing patterns and emerging bacterial resistance. Arch Intern Med. 2000;160:2819–22.
doi: 10.1001/archinte.160.18.2819
pubmed: 11025792
Macy E. Penicillin allergy: optimizing diagnostic protocols, public health implications, and future research needs. Curr Opin Allergy Clin Immunol. 2015;15(4):308–13. https://doi.org/10.1097/ACI.0000000000000173 .
doi: 10.1097/ACI.0000000000000173
pubmed: 26110680
Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients, a cohort study. J Allergy Clin Immunol. 2013;133(3):790–5.
doi: 10.1016/j.jaci.2013.09.021
pubmed: 24188976
Trubiano JA, Beekmann SE, Worth LJ, Polgreen PM, Thursky KA, Slavin MA, Grayson ML, Phillips EJ. Improving antimicrobial stewardship by antibiotic allergy delabeling: evaluation of knowledge, attitude, and practices throughout the emerging infections network. Open Forum Infect Dis. 2016;3(3):153. https://doi.org/10.1093/ofid/ofw153 .
doi: 10.1093/ofid/ofw153
Ramsey A, Staicu ML. Use of a penicillin allergy screening algorithm and penicillin skin testing for transitioning hospitalized patients to first line antibiotic therapy. J Allergy Clin Immunol. 2018;6(4):1349–55. https://doi.org/10.1016/j.jaip.2017.11.012 . (Epub 2017 Dec 11).
doi: 10.1016/j.jaip.2017.11.012
Ramsey A, Mustafa S, Holly A, Staicu M. Direct challenges to penicillin-based antibiotics in the inpatient setting. J Allergy Clin Immunol In Pract. 2020;8(7):2294–301. https://doi.org/10.1016/j.jaip.2020.02.033 .
doi: 10.1016/j.jaip.2020.02.033
Chua KYL, Vogrin S, Bury S, Douglas A, Holmes NE, Tan N, Brusco NK, Hall R, Lambros B, Lean J, Stevenson W, Devchand M, Garrett K, Thursky K, Grayson ML, Slavin MA, Phillips EJ, Trubiano JA. The penicillin allergy delabeling program: a multicenter whole-of-hospital health services intervention and comparative effectiveness study. Clin Infect Dis. 2020;73(3):487–96. https://doi.org/10.1093/cid/ciaa653 .
doi: 10.1093/cid/ciaa653
pmcid: 8326579
Tucker MH, Lomas CM, Ramchandar N, Waldram JD. Amoxicillin challenge without penicillin skin testing in evaluation of penicillin allergy in a cohort of Marine recruits. J Allergy Clin Immunol In Pract. 2017;5(3):813–5.
doi: 10.1016/j.jaip.2017.01.023
Ramsey A, Mustafa SS. A penicillin skin testing initiative in an outpatient allergy office. J Allergy Clin Immunol In Pract. 2018;6:1756.
doi: 10.1016/j.jaip.2018.01.001
Confino-Cohen R, Rosman Y, Meir-Shafrir K, Stauber T, Lachover-Roth I, Herhsko A, Goldberg A. Oral challenge without skin testing safely excludes significant delayed onset penicillin hypersensitivity. J Allergy Clin Immunol In Pract. 2017;5(3):669–75.
doi: 10.1016/j.jaip.2017.02.023
Mill C, Primeau MN, Medoff E, Lejtenyl C, O’Keefe A, Netchiporouk E, et al. Assessing the diagnostic properties of a graded oral provocation challenge for the diagnosis of immediate and non immediate reactions to amoxicillin in children. JAMA Pediatr. 2016;170(6):1–8.
doi: 10.1001/jamapediatrics.2016.0033
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9. https://doi.org/10.1016/j.jclinepi.2007.11.008 .
doi: 10.1016/j.jclinepi.2007.11.008
Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: a critical review of clinimetric properties. Psychother Psychosom. 2022;91(1):8–35. https://doi.org/10.1159/000521288 .
doi: 10.1159/000521288
pubmed: 34991091
Steenvoorden L, Bjoernestad EO, Kvesetmoen TA, Gulsvik AK. De-labelling penicillin allergy in acutely hospitalized patients: a pilot study. BMC Infect Dis. 2021;21(1):1083. https://doi.org/10.1186/s12879-021-06794-1 .
doi: 10.1186/s12879-021-06794-1
pubmed: 34670500
pmcid: 8527685