The Incidence of Antimicrobial Allergies in Hospitalized Patients

Lee, Collin E.; Zembower, Teresa; Fotis, Michael A.; Postelnick, Michael; Greenberger, Paul A.; Peterson, Lance R.; Noskin, Gary A.

doi:10.1001/archinte.160.18.2819

Cited by 323 publications

(121 citation statements)

References 15 publications

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“…Patient self-reported rates for penicillin allergy can be as high as 15% with 10% a generally accepted figure, [105][106][107][108] with true rates of penicillin allergy likely to be much lower. 105,106,109 We therefore used the cost of levofloxacin either orally or intravenously for 10% of patients who required antibiotics.…”

Section: Oscillation In Ards Trial Economic Analysismentioning

confidence: 99%

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Lall

Hamilton

Young

et al. 2015

Health Technology Assessment

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BackgroundPatients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage.ObjectivesTo determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation.DesignA parallel, randomised, unblinded clinical trial.SettingUK intensive care units.ParticipantsMechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment.InterventionsTreatment arm HFOV using a Novalung R100®ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning.Control arm Conventional mechanical ventilation using the devices available in the participating centres.Main outcome measuresThe primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained.ResultsOne hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) −6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40;p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to society per QALY of £88,790 and an ICER for the cost to the NHS per QALY of £78,260.ConclusionsThe use of HFOV had no effect on 30-day mortality in adult patients undergoing mechanical ventilation for ARDS and no economic advantage. We suggest that further research into avoiding ventilator-induced lung injury should concentrate on ventilatory strategies other than HFOV.Trial registrationCurrent Controlled Trials ISRCTN10416500.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 23. See the NIHR Journals Library website for further project information.

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Section: Oscillation In Ards Trial Economic Analysismentioning

confidence: 99%

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Lall

Hamilton

Young

et al. 2015

Health Technology Assessment

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“…The overdiagnosis of penicillin allergy may be due to many factors, such as declining penicillin IgE antibodies over time [7], concomitant viral illnesses with symptoms inappropriately attributed to penicillin allergy [8] or misinterpretation of side effects to medication as allergy. The negative consequences of this mislabeling include limited antibiotic options, the unnecessary use of broad-spectrum antibiotics, increased risk of toxicity and increased healthcare costs [9,10]. Thus, the role of penicillin skin testing (PST) is important in evaluating true penicillin allergy in order to optimize the efficacy of medical care [11].…”

Section: Introductionmentioning

confidence: 99%

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Lin¹,

Saxon²,

Riedl³

2010

Int Arch Allergy Immunol

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Background: Allergy to penicillins remains an important issue. Penicillin skin testing (PST) with major and minor determinants has been shown to be a highly valuable tool for identifying IgE-mediated penicillin allergy. The value of additional testing with side-chain-specific moieties from semisynthetic penicillins such as amoxicillin is not well-established in spite of the widespread use of these medications. Methods: A retrospective review of all consecutive inpatient PST results from 1995 to 2007 comprising 1,068 patients was performed in our institution on individuals with a self-reported history of beta-lactam allergy to assess the importance of including the amoxicillin determinant in a previously validated PST panel. Descriptive statistics were performed. The PST panel included penicilloyl-polylysine, penicillin G, penicilloate, penilloate and amoxicillin. Results: Of 1,068 patients, 243 (23%) had a positive skin test reaction on the PST panel. Testing with amoxicillin was positive in 30.9% of patients, the majority of whom (81%) were also positive to 1 or more standard penicillin reagents. Fourteen of the 243 positive patients (5.8%) had a positive skin test reaction only to amoxicillin. Additionally, the use of penicilloate and penilloate minor determinants in combination with penicillin G identified a greater percentage of penicillin-allergic individuals compared to using only penicillin G (22.6 vs. 6.6%), demonstrating their importance in the PST panel. Conclusions: These data indicate that the inclusion of the amoxicillin determinant appears to identify a small but important group of allergic individuals who may otherwise test negative on a PST panel.

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“…The prevalence of reported penicillin allergy in hospitalized patients is approximately 10%–20%; however, fewer than 1 in 10 individuals carrying this diagnosis are truly allergic [1–5]. Many reaction histories are poorly documented, and in some cases, nonimmunologic side effects are recorded as allergies that persist in patients’ medical records [6].…”

mentioning

confidence: 99%

“…It is well established that many penicillin-“allergic” patients receive therapeutically inferior and potentially harmful alternative antibiotics, resulting in treatment failures and higher rates of Clostridium difficile, as well as drug-resistant infections such as vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus [1, 3, 10, 11]. Furthermore, these patients incur additional expense not only from antibiotic costs but also from increased length of hospitalizations [12].…”

mentioning

confidence: 99%

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Chen

Tarver

Alvarez

et al. 2018

Open Forum Infectious Diseases

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BackgroundPatients reporting penicillin allergy often receive unnecessary and costly broad-spectrum alternatives such as aztreonam with negative consequences. Penicillin allergy testing improves antimicrobial therapy but is not broadly used in hospitals due to insufficient testing resources and short-term expenses. We describe a clinical decision support (CDS) tool promoting pharmacist-administered penicillin allergy testing in patients receiving aztreonam and its benefits toward antimicrobial stewardship and costs.MethodsA CDS tool was incorporated into the electronic medical record, directing providers to order penicillin allergy testing for patients receiving aztreonam. An allergy-trained pharmacist reviewed orders placed through this new guideline and performed skin testing and oral challenges to determine whether these patients could safely take penicillin. Data on tests performed, antibiotic utilization, and cost-savings were compared with patients tested outside the new guideline as part of our institution’s standard stewardship program.ResultsThe guideline significantly increased penicillin allergy testing among patients receiving aztreonam from 24% to 85% (P < .001) while reducing the median delay between admission and testing completion from 3.31 to 1.05 days (P = 0.008). Patients tested under the guideline saw a 58% increase in penicillin exposure (P = .046). Institutional aztreonam administration declined from 2.54 to 1.47 administrations per 1000 patient-days (P = .016). Average antibiotic costs per patient tested before and after CDS decreased from $1265.81 to $592.08 USD, a 53% savings.ConclusionsTargeting penicillin allergy testing to patients on aztreonam yields therapeutic and economic benefits during a single admission. This provides a cost-effective model for inpatient testing.

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The Incidence of Antimicrobial Allergies in Hospitalized Patients

Cited by 323 publications

References 15 publications

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

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