scholarly journals Evaluating Risk Factors for a Positive Oral Challenge Despite Negative Penicillin Skin Testing

2016 ◽  
Vol 137 (2) ◽  
pp. AB38
Author(s):  
Megan S. Motosue ◽  
Sara M. May ◽  
Jay Jin ◽  
Miguel A. Park
Keyword(s):  
Risk Factors ◽  
Skin Testing ◽  
Oral Challenge

scholarly journals The Incidence of Non-Tuberculous Mycobacteria in Infants in Kenya

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Grace Kaguthi ◽  
Videlis Nduba ◽  
Wilfred Murithi ◽  
Suzanne Verver
Keyword(s):  
Risk Factors ◽  
Lung Disease ◽  
Hiv Testing ◽  
Chest Radiography ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Skin Testing ◽  
American Thoracic Society ◽  
Tuberculin Skin Testing ◽  
Western Kenya

There is inadequate understanding of the epidemiology of Non-Tuberculous Mycobacteria (NTM) among infants in high tuberculosis burden countries. The objective of this study was to document the incidence and diversity of NTM disease or colonisation in sputum specimens from infants with presumptive TB, the risk factors, and clinical characteristics, in a high TB and HIV burden setting in Western Kenya. A cohort of 2900 newborns was followed for 1–2 years to assess TB incidence. TB investigations included collection of induced sputa and gastric aspirates for culture and speciation by HAIN®, Tuberculin Skin Testing (TST), HIV testing, and chest radiography. The American Thoracic Society Criteria (ATS) were applied to identify NTM disease. Among 927 (32% of 2900) with presumptive TB, 742 (80%) were investigated. NTM were isolated from 19/742 (2.6%) infants. M. fortuitum was most frequently speciated (32%). Total person-time was 3330 years. NTM incidence was 5.7/1,000 person-years, 95% CI (3.5, 8.7). Infants diagnosed with TB were more likely to have NTM isolation (odds ratio 11.5; 95% CI 3.25, 41.0). None of the infants with NTM isolated met the criteria for NTM disease. The incidence of NTM isolation was comparable to similar studies in Africa. NTM isolation did not meet ATS criteria for disease and could represent colonisation. TB disease appears to be structural lung disease predisposing to NTM colonisation.

scholarly journals The Impact of Penicillin Skin Testing on Aztreonam Stewardship and Cost Savings in Immunocompromised Cancer Patients

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Farnaz Foolad ◽  
Sheila Berlin ◽  
Candice White ◽  
Emma Dishner ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Cost Savings ◽  
Hematologic Malignancies ◽  
Oral Challenge ◽  
Beta Lactam ◽  
History Of ◽  
Antibiotic Cost ◽  
The Impact

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.

scholarly journals Risk Factors for Tuberculosis Conversion in a State Prison

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Robert Hung ◽  
Steven Shelton ◽  
Gary Rischitelli
Keyword(s):  
Risk Factors ◽  
Conversion Rate ◽  
Skin Testing ◽  
Latent Tuberculosis ◽  
Skin Tests ◽  
Purified Protein Derivative ◽  
Medical Chart Review ◽  
Prison Health ◽  
Male Inmates ◽  
Control Study

A case-control study determined the risk factors for latent tuberculosis (TB) conversion among Oregon Department of Correction (ODOC) inmates from July 2000 - July 2001. The first objective was to identity the converters. These were inmates who tested negative for the Purified Protein Derivative (PPD) skin test on entry and subsequently tested positive on annual testing. The second objective was determining the risk factors for conversion by comparing the converters with randomly selected controls. The Correctional Information System (CIS) and Mental Health databases were accessed to obtain health and demographic information. With ninety-nine percent of PPD positive inmates on anti-tuberculosis medications, nearly all male inmates who tested positive from July 00-01 (n = 307) were identified through the ODOC pharmacy records. A medical chart review (276 of 307 or 90%) separated the converters (n = 72) from the reactors who tested positive on entry (n = 123) and the prior positives on medications (n = 81). The conversion rate was 5.0 per 1,000 person-years. Differences between the cases (converters) and controls were analyzed using multivariate logistic regression. The converters were 6 times more likely to be Latino (p < .005) vs. Caucasian, over 19 times less likely to live in medium vs. minimum (p < .001) or maximum vs. minimum (p < .001) security prisons, and over 5 times less likely to live in a medium vs. low (.012 < p < .031) or high vs. low (.002 < p < .007) density prison. They had 1.4-1.5 times fewer PPD skin tests (.002 < p < .009) and lived in 1.5-1.7 times fewer prisons (.005 < p < .017). Age, education, county of incarceration, number of incarcerations, and number of visitors were not found to be significant variables. The results revealed a low conversion rate compared to other U.S. prisons. Prison health officials should consider performing two-step skin testing in order to distinguish the booster phenomenon from intramural conversion.

scholarly journals Antibiotic Skin Testing in the Intensive Care Unit: A Systematic Review

2019 ◽  
Vol 39 (6) ◽  
pp. e1-e9
Author(s):  
Homood A. Alharbi
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Skin Test ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Oral Challenge ◽  
Acute Tolerance ◽  
Care Providers

Background Recent research has shown that a large majority of patients with a history of penicillin allergy are acutely tolerant of penicillins and that there is no clinically significant immunologic cross-reactivity between penicillins and cephalosporins or other β-lactams. The standard test to confirm acute tolerance is challenge with a therapeutic dose. Skin testing is useful only when the culprit antibiotic can haptenate serum proteins and induce an immunoglobulin E–mediated reaction and the clinical history demonstrates such high risk that a direct oral challenge may result in anaphylaxis. Objective To review and evaluate the current practice of skin testing for antibiotics (other than penicillin) in critically ill patients by means of a systematic literature review. Methods This systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Several electronic databases were searched using the following terms: antibiotics, skin test (tests, testing), intensive care, intensive care unit, ICU, critical care, critical care unit. Results Twenty-three articles were identified for inclusion in this review. The results indicate a lack of standardized skin testing for all antibiotics in critical care settings. Oral challenge with nonirritating concentrations of antibiotics can be helpful in determining allergy to these drugs. Conclusions Critical care providers should evaluate antibiotic allergy using nonirritating concentrations before administering antibiotics to patients. Introduction of a standardized skin test for all antibiotics in intensive care unit patients to help select the most appropriate antibiotic treatment regimen might help save lives and reduce costs.

Oral challenge without skin testing in children with suspected non‐severe betalactam hypersensitivity

2019 ◽  
Vol 30 (4) ◽  
pp. 488-490 ◽  
Author(s):  
Guillaume Pouessel ◽  
Nicolas Winter ◽  
Stéphanie Lejeune ◽  
Caroline Thumerelle ◽  
Antoine Deschildre
Keyword(s):  
Skin Testing ◽  
Oral Challenge
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