Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/31743
Title: Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs.
Austin Authors: Mabilat, Claude;Gros, Marie-Françoise;Van Belkum, Alex;Trubiano, Jason ;Blumenthal, Kimberly G;Romano, Antonino;Timbrook, Tristan T
Affiliation: bioMérieux, Medical Affairs, 100 Rue Louis Pasteur, F-69280 Marcy l'Etoile, France.
bioMérieux, Open Innovation and Partnerships, 3 Route du Port Michaud, 38390 La Balme Les Grottes, France.
Infectious Diseases
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Oasi Research Institute-IRCCS, Allergy Unit, Troina, Italy.
bioMérieux, BioFire Diagnostics, Global Medical Affairs, 515 Colorow Drive, Salt Lake City, UT 84108, USA.
Issue Date: Dec-2022
Date: 2022
Publication information: JAC-Antimicrobial Resistance 2022; 4(6)
Abstract: Penicillin allergy, the most frequently reported drug allergy, has been associated with suboptimal antibiotic therapy, increased antimicrobial resistance, increased rates of Clostridioides difficile colonization and infection, as well as extended hospital length of stay and increased cost. Although up to 10% of all patients may report penicillin allergy, most penicillin allergies are not confirmed. As such, most patients with a penicillin allergy can still safely use penicillin and related drugs following a more precise assessment. Herein, we review the current practices and unmet needs in penicillin allergy testing. The diagnostic algorithm is mostly based on a clinical history assessment followed by in vivo testing, i.e. skin test and/or drug challenge. As these tests are labour and resource intensive, there is increased interest in point-of-care penicillin allergy de-labelling solutions incorporated into Antimicrobial Stewardship Programmes including digital assessment tools. These can be locally parameterized on the basis of characteristics of target populations, incidence of specific allergies and local antibiotic usage to perform clinical risk stratification. Safely ruling out any residual risk remains essential and in vivo drug challenge and/or skin testing should be systematically encouraged. Gradual understanding and convergence of the risk stratification of the clinical presentation of penicillin allergy is enabling a wider implementation of this essential aspect of antimicrobial stewardship through digitalized decision tools and in vivo testing. More research is needed to deliver point of care in vitro diagnostic tools to democratize this de-labelling practice, which would be highly beneficial to patient care. This progress, together with better education of patients and clinicians about the availability, efficacy and safety of penicillin allergy testing, will increase the dissemination of penicillin allergy assessment as an important component of Antimicrobial Stewardship Programmes.
URI: https://ahro.austin.org.au/austinjspui/handle/1/31743
DOI: 10.1093/jacamr/dlac116
ORCID: 0000-0003-4773-9817
0000-0002-4542-6203
Journal: JAC-Antimicrobial Resistance
Start page: dlac116
PubMed URL: 36415507
ISSN: 2632-1823
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

32
checked on Oct 4, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.