Risk of meticillin resistant
            <i>Staphylococcus aureus</i>
            and
            <i>Clostridium difficile</i>
            in patients with a documented penicillin allergy: population based matched cohort study

Blumenthal, Kimberly G.; Lu, Na; Zhang, Yuqing; Liu, Yu; Walensky, Rochelle P.; Choi, Hyon K.

doi:10.1136/bmj.k2400

Cited by 261 publications

(197 citation statements)

References 42 publications

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“…• 2014-2018-Impact of penicillin labels on Clostridioides difficile 32,33 • 2016-Recognition of the need to address penicillin allergy by Centers for Disease Control, Infectious Disease Society of America antimicrobial stewardship guidelines 34…”

Section: Acqu Is Iti On Of Peni Cillin Allergy L Ab El Smentioning

confidence: 99%

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: Acqu Is Iti On Of Peni Cillin Allergy L Ab El Smentioning

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

show abstract

“…The effect of choosing different antibiotic classes for perioperative prophylaxis to impact CDI rate is largely unknown, and changing to a lower risk agent could induce undesired risk of a different adverse effect (e.g., nephrotoxicity) . Failing to address penicillin allergies appropriately led to increased non–β‐lactam antibiotics and increased CDI incidence in a recent population‐based matched cohort study . Therefore, antimicrobial stewardship goals to prevent CDI should focus on using the shortest effective duration, fewest number of agents, and antibiotic allergy clarification …”

Section: Restricted and Preferred Antimicrobialsmentioning

confidence: 99%

“…43 Failing to address penicillin allergies appropriately led to increased non-blactam antibiotics and increased CDI incidence in a recent population-based matched cohort study. 44 Therefore, antimicrobial stewardship goals to prevent CDI should focus on using the shortest effective duration, fewest number of agents, and antibiotic allergy clarification. 8…”

Section: Antimicrobial Stewardship Programsmentioning

confidence: 99%

Prevention of Clostridium difficile Infection in Critically Ill Adults

et al. 2019

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The incidence and severity of Clostridium difficile infection (CDI) remain high across intensive care units in the United States despite national efforts to decrease this escalating health care burden. Most published literature and guidelines address treatment rather than prevention, yet this approach may be too downstream to limit morbidity and mortality from the disease and its complications. Mechanisms to prevent CDI successfully include reducing modifiable risk factors and minimizing horizontal transmission of C. difficile spores between patients and the health care environment. Because CDI prevention is characterized by a bundled approach, it is difficult to quantify the individual impact of any one element; however, a number of patient‐ and facility‐level strategies can be considered for CDI prevention. Robust hygiene strategies, diagnostic and antimicrobial stewardship, and particular prophylaxis maneuvers such as continuation of oral vancomycin or fidaxomicin in the setting of systemic antibiotics have all demonstrated benefit. The preventive roles of deprescribing acid suppressants, routine use of probiotics, or early fecal microbiota transplantation remain unclear. The focus of this review is to summarize the evidence related to primary and secondary CDI prevention in critically ill adults and provide a concise implementation pathway for clinicians and policymakers.

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“…The National Institute for Health and Care Excellence said that around 10% of people are documented as having an allergy to penicillin but that only 5% of these have a genuine allergy 12. The advice follows a paper in The BMJ which found that people who were treated as though they had a penicillin allergy were almost 70% more likely to develop MRSA and 25% more likely to develop C difficile because they were treated with broad spectrum antibiotics.…”

Section: Drug Resistancementioning

confidence: 99%

Seven days in medicine: 19-25 September 2018

2018

BMJ

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Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study

Cited by 261 publications

References 42 publications

The challenge of de‐labeling penicillin allergy

The challenge of de‐labeling penicillin allergy

Prevention of Clostridium difficile Infection in Critically Ill Adults

Seven days in medicine: 19-25 September 2018

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