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

Abstract

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.

The 3 Cs of Antibiotic Allergy—Classification, Cross-Reactivity, and Collaboration

“…3, 4, 15 A better measure of the impact of patient-reported antibiotic allergy (so-called antibiotic allergy labels [AALs]) on prescribing is an assessment of antibiotic appropriateness, recent evidence demonstrating such a negative association. 16–18 Li et al . demonstrated also that a penicillin allergy was associated with a 1.82–2.58 fold increase in total antibiotic costs.…”

How antibiotic allergy labels may be harming our most vulnerable patients

“…In an effort to reduce inappropriate hospital antibiotic prescription by frequent antibiotic prescribers, we developed a centralised multidisciplinary antibiotic allergy testing program integrated within our AMS program at Austin Hospital and the Peter MacCallum Cancer Centre. After introducing the program, we found that 83% of patients could have an antibiotic allergy label removed 21 . This finding has particular significance as 48% of patients were immunocompromised, with conditions and treatments including haematological and oncological malignancy, autoimmune disease, solid organ or stem cell transplants, and steroid usage of more than 15 mg daily for 1 month 21 .…”

“…After introducing the program, we found that 83% of patients could have an antibiotic allergy label removed 21 . This finding has particular significance as 48% of patients were immunocompromised, with conditions and treatments including haematological and oncological malignancy, autoimmune disease, solid organ or stem cell transplants, and steroid usage of more than 15 mg daily for 1 month 21 . After testing in this cohort, guideline‐preferred antibiotic prescribing significantly improved (95% [3 months after implementation] v 62% [3 months before implementation]), as did antibiotic appropriateness (adjusted OR, 12.27; 95% CI, 5.00–30.09) 21 .…”

“…This finding has particular significance as 48% of patients were immunocompromised, with conditions and treatments including haematological and oncological malignancy, autoimmune disease, solid organ or stem cell transplants, and steroid usage of more than 15 mg daily for 1 month 21 . After testing in this cohort, guideline‐preferred antibiotic prescribing significantly improved (95% [3 months after implementation] v 62% [3 months before implementation]), as did antibiotic appropriateness (adjusted OR, 12.27; 95% CI, 5.00–30.09) 21 . In another recent Australian study using allergy testing in an emergency department, 81% of patients had their penicillin allergy label removed following penicillin skin testing and oral provocation 22 …”

“…Frequent users of antimicrobials, especially those with an immune‐mediated antibiotic allergy, should be the primary targets for testing services. The establishment of multidisciplinary specialised antibiotic allergy testing referral centres involving allergists, infectious diseases physicians, AMS programs and pharmacists 21 enables centralised testing with minimisation of program costs and provision of specialised interpretation. Centralised antibiotic allergy testing programs integrated within AMS programs providing supervised skin‐testing services — combined with widespread education regarding low rates of β‐lactam cross‐reactivity, development of programmatic oral re‐challenges of low risk patients, and direct de‐labelling of patients with antibiotic‐related side effects — would underpin a collective effort to deliver the most appropriate antibiotic therapy for all patients, particularly those who are most vulnerable.…”