Enhancing antibiotic stewardship by tackling “spurious” penicillin allergy

Krishna, Mamidipudi Thirumala; Huissoon, Aarnoud; Li, M.; Richter, Alex; Pillay, D.; Sambanthan, D.; Raman, Sunita; Nasser, Shuaib; Misbah, Siraj

doi:10.1111/cea.13044

Cited by 70 publications

(66 citation statements)

References 55 publications

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“…60,61 Patients with penicillin allergy labels are also at greater risk for multidrug-resistant infections and use of inappropriate antimicrobials during treatment. It has been shown across several countries and healthcare systems that patients with penicillin allergy labels experience increased rates of infection with multidrug-resistant organisms such as Clostridioides difficile, 32,33,55,58,62 methicillin-resistant Staphylococcus aureus (MRSA), 32,33 and vancomycin-resistant Enterococcus species. 33,62 This increase is likely mediated by use of alternative broad-spectrum antimicrobials that favor selection of these organisms.…”

Section: Imp Ortant Neg Ative Con S Equen Ce S Of Peni Cillin Allermentioning

confidence: 99%

“…It has been shown across several countries and healthcare systems that patients with penicillin allergy labels experience increased rates of infection with multidrug-resistant organisms such as Clostridioides difficile, 32,33,55,58,62 methicillin-resistant Staphylococcus aureus (MRSA), 32,33 and vancomycin-resistant Enterococcus species. 33,62 This increase is likely mediated by use of alternative broad-spectrum antimicrobials that favor selection of these organisms. 76 In the US, pregnant patients with penicillin allergy labels are more likely to receive antibiotics during labor which are ineffective for treatment of group B Streptococcus carriage.…”

Section: Imp Ortant Neg Ative Con S Equen Ce S Of Peni Cillin Allermentioning

confidence: 99%

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The challenge of de‐labeling penicillin allergy

Stone

Trubiano

Coleman

et al. 2019

Allergy

186

160

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Background Even though 8%‐25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy that has waned over time. Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de‐labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus. Methods We performed an evidence‐based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de‐labeling. Over the period 1928‐2018 in Pubmed and Medline, search terms used included “penicillin allergy” or “penicillin hypersensitivity” alone or in combination with “adverse events,” “testing,” “evaluation,” “effects,” “label,” “de‐labeling,” “prick or epicutaneous,” and “intradermal” skin testing, “oral challenge or provocation,” “cross‐reactivity,” and “antimicrobial stewardship”. Results Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance. Conclusions Operationalizing penicillin allergy de‐labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de‐labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs.

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Section: Imp Ortant Neg Ative Con S Equen Ce S Of Peni Cillin Allermentioning

confidence: 99%

Section: Imp Ortant Neg Ative Con S Equen Ce S Of Peni Cillin Allermentioning

confidence: 99%

The challenge of de‐labeling penicillin allergy

Stone

Trubiano

Coleman

et al. 2019

Allergy

186

160

View full text Add to dashboard Cite

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“…Several algorithms aiming to question pre-existing labels of antibiotic allergy have been published in recent years. [2][3][4] While the proposed algorithms accurately consider different reaction patterns by covering the frequent to the extremely rare, they tend to be complex, time-consuming and hardly suitable for everyday practice.…”

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confidence: 99%

De‐labelling antibiotic allergy through five key questions

Reichel

Röding

Stoevesandt

et al. 2020

Clin Experimental Allergy

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“…Penicillins are the first‐line antibiotics for many common infections and sepsis . Six to 10% of the general population and 15–20% of hospital inpatients in the UK and USA carry a penicillin allergy (PenA) label, although emergent research shows that 90–95% of these labels are found to be incorrect following comprehensive allergy testing . Identification and removal of inaccurate and spurious PenA labels is referred to as delabelling.…”

Section: Introductionmentioning

confidence: 99%

“…Focus on antimicrobial stewardship (AMS) and concerns of inappropriate use of antimicrobials has led to greater interest in the impact of spurious PenA labels on clinical and operational outcomes, and a call for global action . Inaccurate PenA labels are a major barrier to AMS and a patient safety concern . Large cohort studies from UK and USA show that PenA labels enhance the risk of serious hospital acquired infections such as methicillin‐resistant Staphylococcus aureus , vancomycin‐resistant Enterococci and Clostridioides difficile infections .…”

Section: Introductionmentioning

confidence: 99%

Sustaining and spreading penicillin allergy delabelling: A narrative review of the challenges for service delivery and patient safety

Jani¹,

Williams

Krishna

2020

Brit J Clinical Pharma

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Many patients report allergies to penicillin, although in over 90% of these the label of penicillin allergy is shown to be incorrect following comprehensive testing. Inappropriate and inaccurate penicillin allergy labelling is a barrier to antimicrobial stewardship and can lead to patient harm. This review assesses an emergent evidence base and trend favouring delabelling using direct oral penicillin challenges following a stratified risk assessment of the likelihood and existence of true penicillin allergy, to identify and make recommendations for key components for implementation in standard practice. Research to date has focussed on the feasibility and clinical and financial outcomes of these direct delabelling strategies. There is a paucity of studies exploring the views and engagement of patients and healthcare professionals, and a gap in the evidence for prerequisites to safely deliver, sustain and spread the implementation of such services across health systems.

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Enhancing antibiotic stewardship by tackling “spurious” penicillin allergy

Cited by 70 publications

References 55 publications

The challenge of de‐labeling penicillin allergy

The challenge of de‐labeling penicillin allergy

De‐labelling antibiotic allergy through five key questions

Sustaining and spreading penicillin allergy delabelling: A narrative review of the challenges for service delivery and patient safety

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