P171 IMPLEMENTATION OF A PENICILLIN SKIN TESTING SERVICE IN INPATIENTS WITH HEMATOLOGIC MALIGNANCIES

Abstract Objective Reported penicillin allergies result in alternative antimicrobial use and are associated with worse outcomes and increased costs. Penicillin skin testing (PST) has recently been shown to be safe and effective in immunocompromised cancer patients, yet its impact on antimicrobial costs and aztreonam utilization has not been evaluated in this population. Method From September 2017 to January 2018, we screened all admitted patients receiving aztreonam. Those with a self-reported history of possible immunoglobulin E (IgE)-mediated reaction to penicillin were eligible for PST with oral challenge. Results A total of 129 patients were screened, and 49 patients were included and underwent testing. Sixteen patients (33%) had hematologic malignancies and 33 patients (67%) had solid tumors. After PST with oral challenge, 46 patients (94%) tested negative, 1 patient tested positive on oral challenge, and 2 patients had indeterminate results. The median time from admission to testing was 2 days (interquartile range, 1–4). After testing negative, 33 patients (72%) were switched to beta-lactam therapy, which resulted in a total of 390 days of beta-lactam therapy. For identical therapy durations, the direct total antibiotic cost was $15 138.89 for beta-lactams versus $78 331.50 for aztreonam, resulting in $63 192.61 in projected savings. A significant reduction in median days of aztreonam therapy per 1000 patient days (10.0 vs 8.0; P = .005) was found during the intervention period. Conclusions Use of PST in immunocompromised cancer patients receiving aztreonam resulted in improved aztreonam stewardship and significant cost savings. Our study demonstrates that PST with oral challenge should be considered in all cancer patients with reported penicillin allergies.

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Feasibility, Benefits, and Limitations of a Penicillin Allergy Skin Testing Service

Annals of Pharmacotherapy ◽

10.1177/1060028017690854 ◽

2017 ◽

Vol 51 (6) ◽

pp. 504-510 ◽

Cited By ~ 4

Author(s):

Prasanna P. Narayanan ◽

Meghan N. Jeffres

Keyword(s):

Health Care ◽

Clinical Outcomes ◽

English Language ◽

Data Extraction ◽

Financial Burden ◽

Skin Testing ◽

The United States ◽

Multidrug Resistant ◽

Penicillin Allergy ◽

Testing Service

Objective: To critically examine the feasibility, benefits, and limitations of an inpatient penicillin skin testing service and how pharmacists can be utilized. Data Sources: A PubMed search was performed from July 2016 through September 2016 using the following search terms: penicillin skin testing, penicillin allergy, β-lactam allergy. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language studies assessing the use of penicillin skin testing as well as management and clinical outcomes of patients with a β-lactam allergy were evaluated. Data Synthesis: The prevalence of people self-identifying as penicillin allergic ranges from 10% to 20% in the United States. Being improperly labeled as penicillin allergic is associated with higher health care costs, worse clinical outcomes, and an increased prevalence of multidrug-resistant infections. Penicillin skin testing can be a tool used to clarify penicillin allergies and has been demonstrated to be a successful addition to antimicrobial stewardship programs in multiple health care settings. Prior to implementing a penicillin skin testing service, institutions will need to perform a feasibility analysis of who will supply labor and accept the financial burden as well as identify if the positive benefits of a penicillin skin testing service overcome the limitations of this diagnostic test. Conclusion: We conclude that institutions with high percentages of patients receiving non–β-lactams because of penicillin allergy labels would likely benefit the most from a penicillin skin testing service.

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Implementation of an Infectious Disease Fellow Managed Penicillin Allergy Skin Testing Service

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv133.980 ◽

2015 ◽

Vol 2 (suppl_1) ◽

Author(s):

Emily Heil ◽

Jacqueline Bork ◽

Ulrike Buchwald

Keyword(s):

Infectious Disease ◽

Skin Testing ◽

Penicillin Allergy ◽

Testing Service ◽

Allergy Skin Testing

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Implementation of an Infectious Disease Fellow-Managed Penicillin Allergy Skin Testing Service

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw155 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 33

Author(s):

Emily L. Heil ◽

Jacqueline T. Bork ◽

Sarah A. Schmalzle ◽

Michael Kleinberg ◽

Anupama Kewalramani ◽

...

Keyword(s):

Skin Testing ◽

Cost Effective ◽

Antibiotic Use ◽

The United States ◽

Effective Therapy ◽

Penicillin Allergy ◽

Antibiotic Selection ◽

Testing Service ◽

Acute Care Facilities ◽

Allergy Skin Testing

Abstract Background. A large percentage of patients presenting to acute care facilities report penicillin allergies that are associated with suboptimal antibiotic therapy. Penicillin skin testing (PST) can clarify allergy histories but is often limited by access to testing. We aimed to implement an infectious diseases (ID) fellow-managed PST program and to assess the need for PST via national survey. Methods. We conducted a prospective observational study of the implementation of an ID fellow-managed penicillin allergy skin testing service. The primary outcome of the study was to assess the feasibility and acceptability of an ID fellow-managed PST service and its impact on the optimization of antibiotic selection. In addition, a survey of PST practices was sent out to all ID fellowship program directors in the United States. Results. In the first 11 months of the program, 90 patients were assessed for PST and 76 patients were tested. Of the valid tests, 96% were negative, and 84% with a negative test had antibiotic changes; 63% received a narrower spectrum antibiotic, 80% received more effective therapy, and 61% received more cost-effective therapy. The majority of survey of respondents (n = 50) indicated that overreporting of penicillin allergy is a problem in their practice that affects antibiotic selection but listed inadequate personnel and time as the main barriers to PST. Conclusions. Inpatient PST can be successfully managed by ID fellows, thereby promoting optimal antibiotic use in patients reporting penicillin allergies. This model can increase access to PST at institutions without adequate access to allergists while also providing an important educational experience to ID trainees.

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2676. Effect of β-Lactam Allergy on Appropriateness of Antibiotic Use in Patients with Febrile Neutropenia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2354 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S939-S939

Author(s):

Zachary A Yetmar ◽

Prakhar Vijayvargiya ◽

Pritish Tosh ◽

Mary J Kasten

Keyword(s):

Febrile Neutropenia ◽

Hematologic Malignancy ◽

Skin Testing ◽

Antibiotic Use ◽

Hematologic Malignancies ◽

Antibiotic Administration ◽

Solid Organ ◽

Usage Patterns ◽

Treatment Data ◽

History Of

Abstract Background Over 80% of patients with hematologic malignancies develop some form of infectious complication, most commonly febrile neutropenia. Patients with febrile neutropenia have 10% mortality, which increases if antibiotic administration is delayed past 30 minutes. Studies have suggested β-lactam allergy may delay administration of antibiotic while putting patients at greater risk for inappropriate antibiotic choice and adverse effects stemming from this. We sought to describe the risks associated with β-lactam allergy in the neutropenic population. Methods We conducted a retrospective, descriptive study from January 2016 to December 2017 identifying patients with febrile neutropenia and a reported history of β-lactam allergy. Baseline characteristics, allergy data, treatment data, and outcomes were collected and analyzed. Results We identified 31 patients with febrile neutropenia and β-lactam allergy during this time period. Etiologies of neutropenia were hematologic malignancy (61.2%), stem cell transplantation (12.9%), solid-organ malignancy (22.6%), and autoimmune (3.3%). Reported reactions to β-lactams were rash (41.9%), hives (9.7%), anaphylaxis (3.2%), other (9.7%), and unknown (35.5%). Average time to antibiotic administration was 142.5 minutes. Antibiotic choice was cefepime (61.3%), piperacillin–tazobactam (6.5%), carbapenem (22.6%), fluoroquinolone (6.5%), cefepime and fluoroquinolone (3.2%), and vancomycin (58.1%). 51.6% received initial antibiotics consistent with the 2010 IDSA guidelines. Six patients underwent penicillin skin testing, all negative. 1 patient developed C. difficile infection, 1 developed MRSA colonization, and 3 developed VRE colonization. Mortality was 3.2% at 30 days and 16.1% at 90 days. Conclusion Our study estimated the antibiotic usage patterns and outcomes in patients with febrile neutropenia and reported β-lactam allergy. This showed low adherence to an established guideline for antibiotic choice in these patients. With rising antimicrobial resistance, there is a need to develop strategies to reduce inappropriate antimicrobial use, especially in patients with febrile neutropenia. Preemptive β-lactam allergy evaluation warrants further evaluation in the neutropenic population. Disclosures All authors: No reported disclosures.

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