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Title: The Penicillin Allergy Delabeling Program: A Multicenter Whole-of-Hospital Health Services Intervention and Comparative Effectiveness Study.
Austin Authors: Chua, Kyra Y L ;Vogrin, Sara;Bury, Susan;Douglas, Abby;Holmes, Natasha E ;Tan, Nixon;Brusco, Natasha K;Hall, Rebecca;Lambros, Belinda;Lean, Jacinta;Stevenson, Wendy;Devchand, Misha ;Garrett, Kent ;Thursky, Karin;Grayson, M Lindsay ;Slavin, Monica A;Phillips, Elizabeth J;Trubiano, Jason A 
Affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Australia
Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia
Department of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia
Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Australia
National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital, Melbourne, Australia
Infectious Diseases
Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, Australia
Alpha Crucis Group, Health Economics, Langwarrin, Australia
Department of Infectious Diseases and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Australia
Centre for Antibiotic Allergy and Research
Issue Date: 5-Aug-2020 2020
Publication information: Clinical Infectious Diseases 2020; online first: 5 August
Abstract: Penicillin allergies are associated with inferior patient and antimicrobial stewardship outcomes. We implemented a whole-of-hospital program to assess the efficacy of inpatient delabeling for low-risk penicillin allergies in hospitalized inpatients. Patients ≥ 18 years of age with a low-risk penicillin allergy were offered a single-dose oral penicillin challenge or direct label removal based on history (direct delabeling). The primary endpoint was the proportion of patients delabeled. Key secondary endpoints were antibiotic utilization pre- (index admission) and post-delabeling (index admission and 90 days). Between 21 January 2019 and 31 August 2019, we assessed 1791 patients reporting 2315 antibiotic allergies, 1225 with a penicillin allergy. Three hundred fifty-five patients were delabeled: 161 by direct delabeling and 194 via oral penicillin challenge. Ninety-seven percent (194/200) of patients were negative upon oral penicillin challenge. In the delabeled patients, we observed an increase in narrow-spectrum penicillin usage (adjusted odds ratio [OR], 10.51 [95% confidence interval {CI}, 5.39-20.48]), improved appropriate antibiotic prescribing (adjusted OR, 2.13 [95% CI, 1.45-3.13]), and a reduction in restricted antibiotic usage (adjusted OR, 0.38 [95% CI, .27-.54]). In the propensity score analysis, there was an increase in narrow-spectrum penicillins (OR, 10.89 [95% CI, 5.09-23.31]) and β-lactam/β-lactamase inhibitors (OR, 6.68 [95% CI, 3.94-11.35]) and a reduction in restricted antibiotic use (OR, 0.52 [95% CI, .36-.74]) and inappropriate prescriptions (relative risk ratio, 0.43 [95% CI, .26-.72]) in the delabeled group compared with the group who retained their allergy label. This health services program using a combination of direct delabeling and oral penicillin challenge resulted in significant impacts on the use of preferred antibiotics and appropriate prescribing.
DOI: 10.1093/cid/ciaa653
PubMed URL: 32756983
Type: Journal Article
Subjects: antibiotic allergy
antimicrobial stewardship
direct provocation
oral challenge
penicillin allergy
Appears in Collections:Journal articles

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