Risk stratification in beta-lactam allergy

2021 ◽  
Author(s):  
Tugba Arikoglu ◽  
Aylin Ozhan Kont ◽  
Ali Demirhan ◽  
Burcu Caglar Yuksek ◽  
Nazan Tokmeci ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Beta Lactam

scholarly journals Suspected penicillin allergy: risk assessment using an algorithm as an antibiotic stewardship project

2020 ◽  
Vol 29 (6) ◽  
pp. 174-180
Author(s):  
Christiane Querbach ◽  
Tilo Biedermann ◽  
Dirk H. Busch ◽  
Rüdiger Eisenhart-Rothe ◽  
Susanne Feihl ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Bacterial Infections ◽  
University Hospital ◽  
Beta Lactam ◽  
Delayed Reaction ◽  
Allergy Testing ◽  
Beta Lactam Antibiotics ◽  
Patient Reported ◽  
Provocation Testing ◽  
Reliable Solution

Summary Background Beta-lactam antibiotics (BLA) are the treatment of choice for a large number of bacterial infections. Putative BLA allergies are often reported by patients, but rarely confirmed. Many patients do not receive BLA due to suspected allergy. There is no systematic approach to risk stratification in the case of a history of suspected BLA allergy. Methods Using the available stratification programs and taking current guidelines into account, an algorithm for risk stratification, including recommendations on the use of antibiotics in cases of compellingly indicated BLA despite suspected BLA allergy, was formulated by the authors for their maximum care university hospital. Results The hospital is in great need of recommendations on how to deal with BLA allergies. Patient-reported information in the history forms the basis for classifying the reactions into four risk categories: (1) BLA allergy excluded, (2) benign delayed reaction, (3) immediate reaction, and (4) severe cutaneous and extracutaneous drug reaction. Recommendations strictly depend on this classification and range from use of full-dose BLA or use of BLA under certain conditions (e.g., two-stage dose escalation, non-cross-reactive BLA only) to prohibiting all BLA and the use of alternative non-BLA. In case of suspected immediate or delayed allergic reactions, there is an additional recommendation regarding subsequent allergy testing during a symptom-free interval. Conclusion Triage of patients with suspected BLA is urgently required. While allergy testing, including provocation testing, represents the most reliable solution, this is not feasible in all patients due to the high prevalence of BLA allergies. The risk stratification algorithm developed for the authors’ hospital represents a tool suitable to making a contribution to rational antibiotic therapy.

Risk Stratification and Prediction in Beta-Lactam Allergic Patients

2019 ◽  
Vol 7 (7) ◽  
pp. 2182-2184 ◽  
Author(s):  
Allison Ramsey ◽  
Jean-Christoph Caubet ◽  
Kimberly Blumenthal
Keyword(s):  
Risk Stratification ◽  
Beta Lactam

scholarly journals 1127. Validation of an Adult and Pediatric Beta-Lactam Allergy Risk Stratification Tool

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S654-S655
Author(s):  
Rupal K Jaffa ◽  
Minh-Thi Ton ◽  
Jeanne Forrester ◽  
Rupal Patel ◽  
Courtney W Brantley ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Lower Risk ◽  
Pediatric Patients ◽  
Risk Category ◽  
Beta Lactam ◽  
Risk Levels ◽  
Difficulty Breathing ◽  
Risk Stratification Tool ◽  
Ige Mediated ◽  
Pediatric Providers

Abstract Background Penicillin allergies are commonly reported, yet more than 95% of these patients can tolerate β-lactams. A comprehensive allergy history is essential when determining which patients can safely receive a β-lactam but is rarely obtained. When available, interpretation of the history is often limited by lack of comfort in determining risk of an allergic reaction. Our antimicrobial stewardship and allergy team created a standardized allergy history questionnaire and risk stratification tool. The purpose of this study was to validate this tool by comparing risk levels assigned by various clinicians to that assigned by an allergist. Methods We prospectively identified 50 adult and 50 pediatric patients hospitalized between July 1, 2020 and March 31, 2021 with an allergy to penicillin, amoxicillin, ampicillin, or cephalexin. Patients with severe non-IgE mediated reactions were excluded. All patients (or caregivers) were interviewed by the same pharmacist using the allergy questionnaire. Clinicians from various subspecialties, including an adult and pediatric allergist, an adult and pediatric infectious diseases (ID) physician, an adult and pediatric hospitalist, and an adult and pediatric ID pharmacist, received anonymized completed questionnaires and the risk stratification tool, but were blinded to other clinicians’ responses. The primary endpoint was overall concordance in risk stratification between non-allergists and allergists. Results Overall concordance was 66% (33/50) in adult and 90% (45/50) in pediatric patients (Table 1). Concordance between individual clinicians and the allergist are shown in Figure 1. In adults, anaphylaxis, difficulty breathing, and angioedema were associated with less severe stratification by non-allergists than allergists. No clinicians stratified any pediatric patient into a lower risk category than the allergist. Table 1. Clinician Agreement with Allergist Figure 1. Risk Stratification Severity Compared to Allergist Conclusion Use of a β-lactam allergy risk stratification tool led to agreement with allergist assessment in the majority of patients. Variation in risk assignment was greater in adult patients; however, non-allergist pediatric providers assigned all patients at the same or more severe level as the allergist, indicating safety in this population. Disclosures All Authors: No reported disclosures

Morphologic alterations in bacteroides fragilis following single and combinant beta-lactam exposure

1986 ◽  
Vol 44 ◽  
pp. 304-305
Author(s):  
Michael P. Goheen ◽  
Charles E. Edmiston
Keyword(s):  
Bacteroides Fragilis ◽  
Synergistic Activity ◽  
Beta Lactam ◽  
Clinical Strains ◽  
Drug Activity ◽  
Obligate Anaerobic ◽  
Morphologic Changes

The synergistic activity of antimicrobial combinants against aerobic and facultative microorganisms has been well documented. in comparison, few studies have been performed using obligate anaerobic isolates and antimicrobial combinants. For this study clinical strains of Bacteroides fragilis(BF) were selected to investigate both single/combinant drug activity and cellular morphologic changes when BF is exposed to Imipenem (I), Piperacillin (P), Cefpimizole (C), Imipenem/Piperacillin (I+P), and Imipenem/Cefpimizole (I+C).

Abstract #564 Advanced Ultrasound Application- Impact on Presurgical Risk Stratification of Thyroid Nodules

2019 ◽  
Vol 25 ◽  
pp. 287
Author(s):  
Andreea Borlea ◽  
Dana Stoian ◽  
Adrian Apostol ◽  
Mihnea Derban ◽  
Laura Cotoi ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Thyroid Nodules ◽  
Ultrasound Application

Plasma Biomarkers Refine Risk Stratification

2011 ◽  
Vol 6 (4) ◽  
pp. 36-37
Author(s):  
SUSAN LONDON
Keyword(s):  
Risk Stratification ◽  
Plasma Biomarkers
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