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Clin Infect Dis. 2017 Jul 1;65(1):166-174. doi: 10.1093/cid/cix244.

Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicenter Evaluation.

Author information

1
Department of Infectious Diseases, Austin Health, Heidelberg.
2
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria Comprehensive Cancer Centre (VCCC).
3
Department of Medicine, University of Melbourne, Parkville.
4
National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital.
5
Centre for Improving Cancer Outcomes Through Enhanced Infection Services, National Health and Medical Research Council Centre of Research Excellence, Sir Peter MacCallum Department of Oncology, University of Melbourne.
6
Department of Pharmacy, Austin Health, Heidelberg.
7
Department of Pharmacy, Peter MacCallum Cancer Centre, VCCC, Parkville.
8
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria.
9
Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
10
Departments of Medicine and Pharmacology, Vanderbilt University Medical Centre, Nashville, Tennessee.

Abstract

Background:

Despite the high prevalence of patient-reported antibiotic allergy (so-called antibiotic allergy labels [AALs]) and their impact on antibiotic prescribing, incorporation of antibiotic allergy testing (AAT) into antimicrobial stewardship (AMS) programs (AAT-AMS) is not widespread. We aimed to evaluate the impact of an AAT-AMS program on AAL prevalence, antibiotic usage, and appropriateness of prescribing.

Methods:

AAT-AMS was implemented at two large Australian hospitals during a 14-month period beginning May 2015. Baseline demographics, AAL history, age-adjusted Charlson comorbidity index, infection history, and antibiotic usage for 12 months prior to testing (pre-AAT-AMS) and 3 months following testing (post-AAT-AMS) were recorded for each participant. Study outcomes included the proportion of patients who were "de-labeled" of their AAL, spectrum of antibiotic courses pre- and post-AAT-AMS, and antibiotic appropriateness (using standard definitions).

Results:

From the 118 antibiotic allergy-tested patients, 226 AALs were reported (mean, 1.91/patient), with 53.6% involving 1 or more penicillin class drug. AAT-AMS allowed AAL de-labeling in 98 (83%) patients-56% (55/98) with all AALs removed. Post-AAT, prescribing of narrow-spectrum penicillins was more likely (adjusted odds ratio [aOR], 2.81, 95% confidence interval [CI], 1.45-5.42), as was narrow-spectrum β-lactams (aOR, 3.54; 95% CI, 1.98-6.33), and appropriate antibiotics (aOR, 12.27; 95% CI, 5.00-30.09); and less likely for restricted antibiotics (aOR, 0.16; 95% CI, .09-.29), after adjusting for indication, Charlson comorbidity index, and care setting.

Conclusions:

An integrated AAT-AMS program was effective in both de-labeling of AALs and promotion of improved antibiotic usage and appropriateness, supporting the routine incorporation of AAT into AMS programs.

KEYWORDS:

allergy testing; antibiotic allergy; antimicrobial resistance; penicillin allergy

PMID:
28520865
PMCID:
PMC5849110
DOI:
10.1093/cid/cix244
[Indexed for MEDLINE]
Free PMC Article

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