The impact of antimicrobial allergy labels on antimicrobial usage in cancer patients

Abstract

BackgroundAntibiotic allergy labels are associated with sub-optimal prescribing patterns and poorer clinical outcomes in non-cancer populations, but the effect of labelling on antimicrobial usage in patients with cancer is unknown.FindingsA retrospective review of hospitalized patients admitted to the Peter MacCallum Cancer Centre (2010-2012) identified 23 % of cancer patients (n = 198) with an antimicrobial allergy label (AA). Comparison of those with an antimicrobial allergy label to those without demonstrated increased antibiotic use per admission (3 vs. 2, p = 0.01), increased fluoroquinolone use (11 % vs. 6 %, p < 0.05), increased antibiotic course duration (15 vs. 13 days, p = 0.09), higher readmission rates (53 % vs. 28 %, p < 0.001) and poorer concordance with prescribing guidelines (47 % vs. 91 %, p < 0.001). Patients in the AA group on multivariate analysis had a higher number of antibiotics employed, longer duration of antibiotic therapy and higher rate of readmission.ConclusionsAntimicrobial usage, including the use of restricted antibiotics, is higher in patients with cancer. Antibiotic de-labelling strategies in cancer patients must be evaluated to aid antimicrobial stewardship initiatives.

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

“…2–6 Reducing the prevalence and burden of antibiotic allergies requires the engagement of key stakeholders such as allergists, immunologists, pharmacists and infectious diseases physicians. 3, 7–9 …”

Current State of Antimicrobial Stewardship at Solid Organ and Hematopoietic Cell Transplant Centers in the United States

“…Because poorer guideline concordance, increased duration of therapy, and higher readmission rates have been reported in immunocompromised patients labeled with a drug allergy, ASPs can also consider initiatives to improve drug allergy assessments. 1,21 Antimicrobial cycling was rarely performed, a finding compatible with the lack of endorsement by the 2016 IDSA/SHEA guideline. 1 …”

Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice

“…Notably, a cephalosporin‐containing regimen was selected by 11% for beta‐lactam anaphylaxis despite the potential for 5% cross‐reactivity with these agents . Antibiotic allergy in the adult cancer population is associated with increased antibiotic duration, inappropriate prescribing and higher readmission rates, suggesting that guidelines should address allergy recommendations, and antibiotic allergy de‐labelling strategies are employed …”