Impact of antimicrobial stewardship interventions on peripartum antibiotic prescribing in patients with penicillin allergy

BackgroundUnconfirmed beta‐lactam allergy in pregnant people has been associated with higher morbidity, unnecessary exposure to broad‐spectrum antibiotics and prolonged hospitalisation. There are no published data on beta‐lactam allergies in pregnant people in Australia.AimsThe aim was to describe patient‐reported beta‐lactam allergies and appropriateness for antibiotic allergy de‐labelling in a maternity cohort in Australia.MethodsMaternity patients aged ≥18 years admitted to our institution between March 2021 and June 2021 with a beta‐lactam allergy documented in their electronic medical record were interviewed for details of their allergy. The documented allergies were compared to the allergy history obtained from the interview. Severity of the allergy was rated, and appropriateness for allergy de‐labelling was assessed using the Victorian Therapeutics Advisory Group beta‐lactam antibiotic allergy assessment tool.ResultsOne hundred and fifty‐three beta‐lactam allergies (182 reactions) were reported by 145 patients. Penicillin class antibiotics were the most frequently implicated, including unspecified penicillins (95/153, 62%), amoxicillin (19/153, 13%) and amoxicillin‐clavulanate (8/153, 5%). Allergy documentation required amending in 52 of 145 patients (36%); 85 of 153 (56%) of the beta‐lactam allergies were considered low risk and potentially appropriate for direct oral re‐challenge.ConclusionBeta‐lactam allergies were inaccurately documented in more than one third of the maternity patients included in our study. As such, education of maternity care providers about the importance of accurate allergy history taking remains an urgent unmet need. Furthermore, allergy assessment and de‐labelling during pregnancy should be considered in maternity patients to optimise antibiotic prescribing and to improve maternal and neonatal health outcomes.

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Recent development and fighting strategies for lincosamide antibiotic resistance

Yang,

Xie,

et al. 2024

Clin Microbiol Rev

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SUMMARY Lincosamides constitute an important class of antibiotics used against a wide range of pathogens, including methicillin-resistant Staphylococcus aureus . However, due to the misuse of lincosamide and co-selection pressure, the resistance to lincosamide has become a serious concern. It is urgently needed to carefully understand the phenomenon and mechanism of lincosamide resistance to effectively prevent and control lincosamide resistance. To date, six mobile lincosamide resistance classes, including lnu , cfr , erm , vga , lsa , and sal, have been identified. These lincosamide resistance genes are frequently found on mobile genetic elements (MGEs), such as plasmids, transposons, integrative and conjugative elements, genomic islands, and prophages. Additionally, MGEs harbor the genes that confer resistance not only to antimicrobial agents of other classes but also to metals and biocides. The ultimate purpose of discovering and summarizing bacterial resistance is to prevent, control, and combat resistance effectively. This review highlights four promising strategies, including chemical modification of antibiotics, the development of antimicrobial peptides, the initiation of bacterial self-destruct program, and antimicrobial stewardship, to fight against resistance and safeguard global health.

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Impact of antimicrobial stewardship interventions on peripartum antibiotic prescribing in patients with penicillin allergy

Cited by 3 publications

References 31 publications

Cefazolin as the mainstay for antibiotic prophylaxis in patients with a penicillin allergy in obstetrics and gynecology

Cefazolin as the mainstay for antibiotic prophylaxis in patients with a penicillin allergy in obstetrics and gynecology

Beta‐lactam allergy risk stratification in a maternity population in Australia: Scope for allergy de‐labelling

Recent development and fighting strategies for lincosamide antibiotic resistance

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