The Penicillin Allergy Delabeling Program: A Multicenter Whole-of-Hospital Health Services Intervention and Comparative Effectiveness Study

被引：95
|
作者：
Chua, Kyra Y. L. [1 ,2 ]
Vogrin, Sara [3 ]
Bury, Susan [1 ,2 ,4 ]
Douglas, Abby [5 ,6 ]
Holmes, Natasha E. [1 ,2 ]
Tan, Nixon [1 ,2 ]
Brusco, Natasha K. [7 ,8 ]
Hall, Rebecca [1 ,2 ]
Lambros, Belinda [5 ,6 ]
Lean, Jacinta [5 ,6 ]
Stevenson, Wendy [1 ,2 ]
Devchand, Misha [1 ,2 ,4 ]
Garrett, Kent [4 ]
Thursky, Karin [5 ,6 ,9 ,10 ]
Grayson, M. Lindsay [1 ,2 ,11 ]
Slavin, Monica A. [5 ,6 ,10 ]
Phillips, Elizabeth J. [12 ,13 ]
Trubiano, Jason A. [1 ,2 ,5 ,6 ,11 ]
机构：
[1] Austin Hlth, Dept Infect Dis, Heidelberg, Vic, Australia
[2] Austin Hlth, Ctr Antibiot Allergy & Res, Heidelberg, Vic, Australia
[3] Univ Melbourne, Dept Med, St Vincents Hosp, Fitzroy, Vic, Australia
[4] Austin Hlth, Dept Pharm, Heidelberg, Vic, Australia
[5] Peter MacCallum Canc Ctr, Dept Infect Dis, Parkville, Vic, Australia
[6] Peter MacCallum Canc Ctr, Natl Ctr Infect Canc, Parkville, Vic, Australia
[7] Alpha Crucis Grp, Hlth Econ, Langwarrin, Australia
[8] Monash Univ, Rehabil Ageing & Independent Living Res Ctr, Frankston, Australia
[9] Royal Melbourne Hosp, Natl Ctr Antimicrobial Stewardship, Melbourne, Vic, Australia
[10] Univ Melbourne, Sir Peter MacCallum Canc Ctr, Dept Oncol, Parkville, Vic, Australia
[11] Univ Melbourne, Dept Med, Austin Hlth, Heidelberg, Vic, Australia
[12] Vanderbilt Univ, Dept Infect Dis, Med Ctr, Nashville, TN USA
[13] Murdoch Univ, Inst Immunol & Infect Dis, Murdoch, WA, Australia
来源：
CLINICAL INFECTIOUS DISEASES | 2021年 / 73卷 / 03期
基金：
英国医学研究理事会; 美国国家卫生研究院;
关键词：
antimicrobial stewardship; antibiotic allergy; penicillin allergy; oral challenge; direct provocation; ANTIBIOTIC ALLERGY; CHALLENGE; STEWARDSHIP;
D O I：
10.1093/cid/ciaa653
中图分类号：
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号：
100102 ;
摘要：
Background. Penicillin allergies are associated with inferior patient and antimicrobial stewardship outcomes. We implemented a whole-of-hospital program to assess the efficacy of inpatient delabeling for low-risk penicillin allergies in hospitalized inpatients. Methods. Patients >= 18 years of age with a low-risk penicillin allergy were offered a single-dose oral penicillin challenge or direct label removal based on history (direct delabeling). The primary endpoint was the proportion of patients delabeled. Key secondary endpoints were antibiotic utilization pre- (index admission) and post-delabeling (index admission and 90 days). Results. Between 21 January 2019 and 31 August 2019, we assessed 1791 patients reporting 2315 antibiotic allergies, 1225 with a penicillin allergy. Three hundred fifty-five patients were delabeled: 161 by direct delabeling and 194 via oral penicillin challenge. Ninety-seven percent (194/200) of patients were negative upon oral penicillin challenge. In the delabeled patients, we observed an increase in narrow-spectrum penicillin usage (adjusted odds ratio [OR], 10.51 [95% confidence interval {CI}, 5.39-20.48]), improved appropriate antibiotic prescribing (adjusted OR, 2.13 [95% CI, 1.45-3.13]), and a reduction in restricted antibiotic usage (adjusted OR, 0.38 [95% CI, .27-.54]). In the propensity score analysis, there was an increase in narrow-spectrum penicillins (OR, 10.89 [95% CI, 5.09-23.31]) and beta-lactam/beta-lactamase inhibitors (OR, 6.68 [95% CI, 3.94-11.35]) and a reduction in restricted antibiotic use (OR, 0.52 [95% CI, .36-.74]) and inappropriate prescriptions (relative risk ratio, 0.43 [95% CI, .26-.72]) in the delabeled group compared with the group who retained their allergy label. Conclusions. This health services program using a combination of direct delabeling and oral penicillin challenge resulted in significant impacts on the use of preferred antibiotics and appropriate prescribing.
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页码：487 / 496
页数：10
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