Journal article
Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicenter Evaluation
Clinical Infectious Diseases, Vol.65(1), pp.166-174
2017
Abstract
Background. Despite the high prevalence of patient-reported antibiotic allergy (so-called antibiotic allergy labels [AALs]) and their impact on antibiotic prescribing, incorporation of antibiotic allergy testing (AAT) into antimicrobial stewardship (AMS) programs (AAT-AMS) is not widespread. We aimed to evaluate the impact of an AAT-AMS program on AAL prevalence, antibiotic usage, and appropriateness of prescribing.
Methods. AAT-AMS was implemented at two large Australian hospitals during a 14-month period beginning May 2015. Baseline demographics, AAL history, age-adjusted Charlson comorbidity index, infection history, and antibiotic usage for 12 months prior to testing (pre-AAT-AMS) and 3 months following testing (post-AAT-AMS) were recorded for each participant. Study outcomes included the proportion of patients who were "de-labeled" of their AAL, spectrum of antibiotic courses pre- and post-AAT-AMS, and antibiotic appropriateness (using standard definitions).
Results. From the 118 antibiotic allergy-tested patients, 226 AALs were reported (mean, 1.91/patient), with 53.6% involving 1 or more penicillin class drug. AAT-AMS allowed AAL de-labeling in 98 (83%) patients-56% (55/98) with all AALs removed. Post-AAT, prescribing of narrow-spectrum penicillins was more likely (adjusted odds ratio [aOR], 2.81, 95% confidence interval [CI], 1.45-5.42), as was narrow-spectrum beta-lactams (aOR, 3.54; 95% CI, 1.98-6.33), and appropriate antibiotics (aOR, 12.27; 95% CI, 5.00-30.09); and less likely for restricted antibiotics (aOR, 0.16; 95% CI,.09-.29), after adjusting for indication, Charlson comorbidity index, and care setting.
Conclusions. An integrated AAT-AMS program was effective in both de-labeling of AALs and promotion of improved antibiotic usage and appropriateness, supporting the routine incorporation of AAT into AMS programs.
Details
- Title
- Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicenter Evaluation
- Authors/Creators
- J.A. Trubiano (Author/Creator) - Peter MacCallum Cancer CentreK.A. Thursky (Author/Creator) - Peter MacCallum Cancer CentreA.J. Stewardson (Author/Creator) - Austin HealthK. Urbancic (Author/Creator) - National Health and Medical Research CouncilL.J. Worth (Author/Creator) - National Health and Medical Research CouncilC. Jackson (Author/Creator) - Peter MacCallum Cancer CentreW. Stevenson (Author/Creator) - Austin HealthM. Sutherland (Author/Creator) - Austin HealthM.A. Slavin (Author/Creator) - Peter MacCallum Cancer CentreM.L. Grayson (Author/Creator) - The University of MelbourneE.J. Phillips (Author/Creator) - Murdoch University
- Publication Details
- Clinical Infectious Diseases, Vol.65(1), pp.166-174
- Publisher
- University of Chicago Press
- Identifiers
- 991005542189607891
- Copyright
- © 2017 Infectious Diseases Society of America
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
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- 1 Clinical & Life Sciences
- 1.265 Dermatology - Skin Allergies
- 1.265.1140 Drug Hypersensitivity
- Web Of Science research areas
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- Infectious Diseases
- Microbiology
- ESI research areas
- Immunology