Antibiotic desensitization as a potential tool in antimicrobial stewardship programs: retrospective data analysis and systematic literature review

Rodriguez-Alarcón, Alicia; Barceló-Vidal, Jaime; Echeverría-Esnal, Daniel; Sorlí, Luisa; Güerri-Fernández, Roberto; Fernández, Sofía Martina Ramis; Benítez-Cano, Adela; Sendra, Elena; López-Montesinos, Inmaculada; Membrilla-Fernández, Estela; Ferrández, Olivia; Adàlia, R.; Horcajada, Juan Pablo; Escolano, F.; Gómez-Zorrilla, Sílvia; Grau, Santiago

doi:10.1080/14787210.2022.2122443

Cited by 3 publications

(10 citation statements)

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“…Since desensitization strategies carry the risk of complications, all patients were transferred to an intensive care unit (ICU) and were strictly monitored and followed during the procedure. The physicians who supervised desensitization were properly trained for the procedure and the nursing team followed a checklist provided by the pharmacy department ( Chen et al, 2019 ; Rodríguez-Alarcón et al, 2022 ). Desensitization bags were prepared in sterile laminar flow cabinets in the pharmacy, following predefined protocols for each antibiotic ( Rodríguez-Alarcón et al, 2022 ).…”

Section: Methodsmentioning

confidence: 99%

“…The physicians who supervised desensitization were properly trained for the procedure and the nursing team followed a checklist provided by the pharmacy department ( Chen et al, 2019 ; Rodríguez-Alarcón et al, 2022 ). Desensitization bags were prepared in sterile laminar flow cabinets in the pharmacy, following predefined protocols for each antibiotic ( Rodríguez-Alarcón et al, 2022 ). Desensitization was not associated with a delay in the administration of antibiotic therapy, since the patient received desensitization within the first few hours after it was prescribed.…”

Section: Methodsmentioning

confidence: 99%

“…There are some strategies available to remove an allergy label, such as skin tests and oral provocation, as well as obtaining a complete allergy history ( Trubiano et al, 2016 ; Trubiano et al, 2017a ; Trubiano et al, 2017b ; Rose et al, 2020 ; Stone et al, 2020 ). Although less widespread, antibiotic desensitization is an option in patients with confirmed or high-risk penicillin allergy ( Habib et al, 2015 ; Paño-Pardo et al, 2022 ; Rodríguez-Alarcón et al, 2022 ). The mechanism of desensitization is to induce tolerance to the drug by administering increasing concentrations of the diluted antibiotic and to prevent anaphylaxis due to inhibition of IgE cross-linking and mast cell degranulation.…”

Section: Introductionmentioning

confidence: 99%

“…This strategy is only useful at the time of active infection. When antibiotic treatment is stopped, it should be performed again ( Rodríguez-Alarcón et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…Prior study suggest that desensitization is well tolerated, even in complex patients with high comorbidity scores ( Rodríguez-Alarcón et al, 2022 ). In clinical practice, the most common indications for desensitization are absence of alternative therapeutic options and therapeutic failure ( Rodríguez-Alarcón et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

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A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs

Rodríguez-Alarcón,

Sanz de Mena,

Alanti

et al. 2023

Front. Pharmacol.

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Introduction: Penicillin allergy labels (PAL) are common in the hospital setting and are associated with worse clinical outcomes. Desensitization can be a useful strategy for allergic patients when alternative options are suboptimal or not available. The aim was to compare clinical outcomes of patients with PAL managed with antibiotic desensitization vs. those who received alternative non-beta-lactam antibiotic treatments.Methods: A retrospective 3:1 case-control study was performed between 2015–2022. Cases were adult PAL patients with infection who required antibiotic desensitization; controls were PAL patients with infection managed with an alternative antibiotic treatment. Cases and controls were adjusted for age, sex, infection source, and critical or non-critical medical services.Results: Fifty-six patients were included: 14 in the desensitization group, 42 in the control group. Compared to the control group, desensitized PAL patients had more comorbidities, with a higher Charlson index (7.4 vs. 5; p = 0.00) and more infections caused by multidrug-resistant (MDR) pathogens (57.1% vs. 28.6%; p = 0.05). Thirty-day mortality was 14.3% in the desensitized group, 28.6% in the control group (p = 0.24). Clinical cure occurred in 71.4% cases and 54.8% controls (p = 0.22). Four control patients selected for MDR strains after alternative treatment; selection of MDR strains did not occur in desensitized patients. Five controls had antibiotic-related adverse events, including Clostridioides difficile or nephrotoxicity. No antibiotic-related adverse events were found in the study group. In multivariate analysis, no differences between groups were observed for main variables.Conclusion: Desensitization was not associated with worse clinical outcomes, despite more severe patients in this group. Our study suggests that antibiotic desensitization may be a useful Antimicrobial Stewardship tool for the management of selected PAL patients.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…This strategy is only useful at the time of active infection. When antibiotic treatment is stopped, it should be performed again ( Rodríguez-Alarcón et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations