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Title: Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicenter Evaluation.
Austin Authors: Trubiano, Jason ;Thursky, Karin A;Stewardson, Andrew J;Urbancic, Karen;Worth, Leon J;Jackson, Cheryl;Stevenson, Wendy;Sutherland, Michael F;Slavin, Monica A;Grayson, M Lindsay ;Phillips, Elizabeth J
Affiliation: Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria Comprehensive Cancer Centre (VCCC), Parkville, Victoria, Australia
Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital, Parkville, Victoria, Australia
Centre for Improving Cancer Outcomes Through Enhanced Infection Services, National Health and Medical Research Council Centre of Research Excellence, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
Department of Pharmacy, Peter MacCallum Cancer Centre, VCCC, Parkville
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Parkville
Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
Departments of Medicine and Pharmacology, Vanderbilt University Medical Centre, Nashville, Tennessee
Issue Date: 1-Jul-2017
Publication information: Clinical Infectious Diseases 2017; 65(1): 166-174
Abstract: Despite the high prevalence of patient-reported antibiotic allergy (so-called antibiotic allergy labels [AALs]) and their impact on antibiotic prescribing, incorporation of antibiotic allergy testing (AAT) into antimicrobial stewardship (AMS) programs (AAT-AMS) is not widespread. We aimed to evaluate the impact of an AAT-AMS program on AAL prevalence, antibiotic usage, and appropriateness of prescribing. AAT-AMS was implemented at two large Australian hospitals during a 14-month period beginning May 2015. Baseline demographics, AAL history, age-adjusted Charlson comorbidity index, infection history, and antibiotic usage for 12 months prior to testing (pre-AAT-AMS) and 3 months following testing (post-AAT-AMS) were recorded for each participant. Study outcomes included the proportion of patients who were "de-labeled" of their AAL, spectrum of antibiotic courses pre- and post-AAT-AMS, and antibiotic appropriateness (using standard definitions). From the 118 antibiotic allergy-tested patients, 226 AALs were reported (mean, 1.91/patient), with 53.6% involving 1 or more penicillin class drug. AAT-AMS allowed AAL de-labeling in 98 (83%) patients-56% (55/98) with all AALs removed. Post-AAT, prescribing of narrow-spectrum penicillins was more likely (adjusted odds ratio [aOR], 2.81, 95% confidence interval [CI], 1.45-5.42), as was narrow-spectrum β-lactams (aOR, 3.54; 95% CI, 1.98-6.33), and appropriate antibiotics (aOR, 12.27; 95% CI, 5.00-30.09); and less likely for restricted antibiotics (aOR, 0.16; 95% CI, .09-.29), after adjusting for indication, Charlson comorbidity index, and care setting. 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.
DOI: 10.1093/cid/cix244
Journal: Clinical Infectious Diseases
PubMed URL: 28520865
Type: Journal Article
Subjects: allergy testing
antibiotic allergy
antimicrobial resistance
penicillin allergy
Appears in Collections:Journal articles

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