P32: STANDARDISED TESTING AND COMMUNICATION INCREASE BETA‐LACTAM ALLERGY DELABELLING EFFECTIVENESS: RESULTS OF ‘DE‐LABELLING PATIENTS WITH ANTIBIOTIC ALLERGY IN SYDNEY ADULT AND PAEDIATRIC HOSPITALS’

Abstract Background and objectives: Antibiotic allergy labels are common and are frequently inaccurate. Previous studies among adults demonstrate that β-lactam allergy labels may lead to adverse outcomes, including prescription of broader-spectrum antibiotics, increased costs, and increased lengths of stay, among others. However, data among pediatric patients are lacking, especially in the United States. In this study, we sought to determine the impact of β-lactam allergy labels in hospitalized children with regards to clinical and economic outcomes. Method: This retrospective cohort study included pediatric patients 30 days to 17 years old, hospitalized at Intermountain Healthcare facilities from 2007 to 2017, who received ≥1 dose of an antibiotic during their admission. Patients with β-lactam allergies were matched to nonallergic patients based on age, sex, clinical service line, admission date, academic children’s hospital or other hospital admission, and the presence of chronic, comorbid conditions. Outcomes included receipt of broader-spectrum antibiotics, clinical outcomes including length of stay and readmission, and antibiotic and hospitalization costs. Results: In total, 38,906 patients were identified. The prevalence of antibiotic allergy increased from 0.9% among those < 1 year peaked at 10.6% by age 17. Patients with β-lactam allergy received broader-spectrum antibiotics and experienced higher antibiotic costs than nonallergic controls. However, there were no differences in the length of stay, readmission rates, or total number of days of antibiotics between allergic and nonallergic patients. Conclusions: Hospitalized pediatric patients with β-lactam allergy labels receive broader-spectrum antibiotics and experience increased antibiotic costs. This represents an important opportunity for allergy delabeling and antibiotic stewardship.

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Pathways to improved antibiotic allergy and antimicrobial stewardship practice: The validation of a beta-lactam antibiotic allergy assessment tool

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2018.07.048 ◽

2019 ◽

Vol 7 (3) ◽

pp. 1063-1065.e5 ◽

Cited By ~ 14

Author(s):

Misha Devchand ◽

Karen F. Urbancic ◽

Sharmila Khumra ◽

Abby P. Douglas ◽

Olivia Smibert ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Assessment Tool ◽

Beta Lactam ◽

Beta Lactam Antibiotic ◽

Antibiotic Allergy ◽

Lactam Antibiotic

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Prevalence and Impact of Reported Drug Allergies among Rheumatology Patients

Diagnostics ◽

10.3390/diagnostics10110918 ◽

2020 ◽

Vol 10 (11) ◽

pp. 918

Author(s):

Shirley Chiu Wai Chan ◽

Winnie Wan Yin Yeung ◽

Jane Chi Yan Wong ◽

Ernest Sing Hong Chui ◽

Matthew Shing Him Lee ◽

...

Keyword(s):

Lupus Erythematosus ◽

Patient Specific ◽

Beta Lactam ◽

Tertiary Referral Hospital ◽

Allergy Testing ◽

Antibiotic Allergy ◽

Lactam Antibiotic ◽

Inflammatory Drugs ◽

Provocation Testing ◽

Rheumatological Diseases

Background: Drug allergies (DA) are immunologically mediated adverse drug reactions and their manifestations depend on a variety of drug- and patient-specific factors. The dysregulated immune system underpinning rheumatological diseases may also lead to an increase in hypersensitivity reactions, including DA. The higher prevalence of reported DA, especially anti-microbials, also restricts the medication repertoire for these already immunocompromised patients. However, few studies have examined the prevalence and impact of reported DA in this group of patients. Methods: Patients with a diagnosis of rheumatoid arthritis (RA), spondyloarthritis (SpA), or systemic lupus erythematosus (SLE) were recruited from the rheumatology clinics in a tertiary referral hospital between 2018 and 2019. Prevalence and clinical outcomes of reported DA among different rheumatological diseases were calculated and compared to a cohort of hospitalized non-rheumatology patients within the same period. Results: A total of 6081 patients (2541 rheumatology patients: 1286 RA, 759 SpA, and 496 SLE; and 3540 controls) were included. DA was more frequently reported among rheumatology patients compared to controls (23.8% vs. 13.8%, p < 0.01). Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) were the two most commonly reported categories of DA with a prevalence of 12.0% and 5.1%, respectively. Reported antibiotics allergies were more frequent in patients with RA (OR = 1.20, 95% CI = 1.02–1.62, p = 0.03) and SLE (OR = 4.69, 95% CI = 3.69–5.95, p < 0.01); and associated with increased infection-related admissions among rheumatology patients (OR = 1.79, 95% CI = 1.09–2.95, p = 0.02). Among the subgroup of patients referred for allergy testing, 85.7% of beta-lactam antibiotic allergy labels were found to be inaccurate and de-labelled after negative drug provocation testing. Conclusion: The prevalence of reported DA was significantly higher in rheumatology patients. Reported antibiotic allergy was associated with increased rate of infection-related admissions. However, the rate of genuine antibiotic allergy was low. Further studies are needed to guide proper assessment of reported DA and impact of comprehensive allergy testing in this group of patients.

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Serious Infections of Hospitalized Patients Are Associated with a Higher Prevalence of Reported Beta Lactam Antibiotic Allergy

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2014.12.1329 ◽

2015 ◽

Vol 135 (2) ◽

pp. AB121 ◽

Cited By ~ 1

Author(s):

Binglin Cai ◽

Barbara A. McGoey ◽

Mary Ann Michelis

Keyword(s):

Hospitalized Patients ◽

Beta Lactam ◽

Beta Lactam Antibiotic ◽

Antibiotic Allergy ◽

Serious Infections ◽

Lactam Antibiotic

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The Long-term Impact of Beta-lactam Antibiotic Allergy Testing - A Matched Case-control Study

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2020.12.097 ◽

2021 ◽

Vol 147 (2) ◽

pp. AB15

Author(s):

Jason Trubiano ◽

Nada Marhoon ◽

Sara Vogrin ◽

Kyra Chua ◽

Natasha Holmes

Keyword(s):

Case Control Study ◽

Case Control ◽

Beta Lactam ◽

Antibiotic Allergy ◽

Lactam Antibiotic ◽

Matched Case ◽

Long Term Impact ◽

Matched Case Control Study ◽

Control Study

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Appropriateness of Beta-Lactam Allergy Record Updates After an Allergy Service Consult

Journal of Pharmacy Practice ◽

10.1177/0897190018797767 ◽

2018 ◽

Vol 33 (3) ◽

pp. 243-246 ◽

Cited By ~ 2

Author(s):

Bryan G. Shaw ◽

Inela Masic ◽

Nancy Gorgi ◽

Niree Kalfayan ◽

Elise M. Gilbert ◽

...

Keyword(s):

Retrospective Study ◽

Hospital Admission ◽

Penicillin Allergy ◽

Memorial Hospital ◽

Inclusion Criteria ◽

Beta Lactam ◽

Outpatient Hospital ◽

Future Treatment ◽

Beta Lactam Antibiotics ◽

Antibiotic Allergy

Background: Many patients with a self-reported penicillin allergy go on to tolerate beta-lactam antibiotics. Allergy specialists may be consulted to determine the nature and extent of the allergy. However, electronic allergy records must be appropriately updated such that recommendations are carried forward. Objective: To determine the percentage of patients who have their electronic allergy record updated after an allergy service consult (ASC). Methods: This was a retrospective study of patients with at least 1 documented beta-lactam allergy and had an ASC during (inpatient) or prior to (outpatient) hospital admission at Northwestern Memorial Hospital and Prentice Women’s Hospital in Chicago, Illinois. Results: Within the study period, a total of 26 526 patients were identified as having a documented antibiotic allergy, with 21 657 patients (81.6% of patients with allergies) having a listed beta-lactam allergy. Of these patients, 1689 (7.8%) patients were identified as having an ASC during or prior to admission, with 598 patients meeting inclusion criteria. Changes in the allergy record were recommended by the ASC for 62% (n = 371) of patients; however, the allergy record was updated after the ASC in 74.9% (n = 278) of patients. Conclusion: ASC recommendations to delabel a patient as beta-lactam allergic must result in updating the allergy record in order to optimize future treatment. Given the low proportion of allergy-labeled patients tested, programs outside formal ASCs should be considered.

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Matched Case-Control Study of the Long-Term Impact of Beta-Lactam Antibiotic Allergy Testing

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01823-20 ◽

2020 ◽

Vol 64 (12) ◽

Author(s):

Jason A. Trubiano ◽

Nada Marhoon ◽

Sara Vogrin ◽

Kyra Y. L. Chua ◽

Natasha E. Holmes

Keyword(s):

Case Control Study ◽

Case Control ◽

Beta Lactam ◽

Allergy Testing ◽

Antibiotic Allergy ◽

Lactam Antibiotic ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study

ABSTRACT Whereas the short-term impacts of antibiotic allergy testing on delabeling and antibiotic usage have been demonstrated, the long-term impacts have been less well defined. In a single-center matched case-control study from Melbourne, Australia, we demonstrate that a beta-lactam antibiotic allergy testing program has a significant impact on antibiotic usage and infection-related outcomes. This study supports implementation of an antibiotic allergy testing program as a standard of care of antimicrobial stewardship programs.

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