The Penicillin Allergy Delabeling Program: A Multicenter Whole-of-Hospital Health Services Intervention and Comparative Effectiveness Study. (5th August 2020)

• Record Type: Journal Article
• Authors: Chua, Kyra Y L; Vogrin, Sara; Bury, Susan; Douglas, Abby; Holmes, Natasha E; Tan, Nixon; Brusco, Natasha K; Hall, Rebecca; Lambros, Belinda; Lean, Jacinta; Stevenson, Wendy; Devchand, Misha; Garrett, Kent; Thursky, Karin; Grayson, M Lindsay; Slavin, Monica A; Phillips, Elizabeth J; Trubiano, Jason A
• Is Part Of: Clinical infectious diseases. Volume 73:Number 3(2021)
• Page Start: 487
• Page End: 496
• Publication Date: 2020-08-05
• Subjects: antimicrobial stewardship -- antibiotic allergy -- penicillin allergy -- oral challenge -- direct provocation; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa653
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: 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 β-lactam/β-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. Abstract : Following penicillin allergy assessment, 355 inpatients were delabeled: 161 by direct delabeling and 194 via direct oral penicillin challenge. In the delabeled patients, there was a significant increase in narrow-spectrum penicillin use, appropriate prescribing, and reduced restricted antibiotic usage.