Journal article
The penicillin allergy delabeling program: A Multicenter Whole-of-Hospital health services intervention and comparative effectiveness study
Clinical Infectious Diseases, Vol.73(3), pp.487-496
2020
Abstract
Background
Penicillin allergies are associated with inferior patient and antimicrobial stewardship outcomes. We implemented a whole-of-hospital program to assess the efficacy of inpatient delabeling for low-risk penicillin allergies in hospitalized inpatients.
Methods
Patients ≥ 18 years of age with a low-risk penicillin allergy were offered a single-dose oral penicillin challenge or direct label removal based on history (direct delabeling). The primary endpoint was the proportion of patients delabeled. Key secondary endpoints were antibiotic utilization pre- (index admission) and post-delabeling (index admission and 90 days).
Results
Between 21 January 2019 and 31 August 2019, we assessed 1791 patients reporting 2315 antibiotic allergies, 1225 with a penicillin allergy. Three hundred fifty-five patients were delabeled: 161 by direct delabeling and 194 via oral penicillin challenge. Ninety-seven percent (194/200) of patients were negative upon oral penicillin challenge. In the delabeled patients, we observed an increase in narrow-spectrum penicillin usage (adjusted odds ratio [OR], 10.51 [95% confidence interval {CI}, 5.39–20.48]), improved appropriate antibiotic prescribing (adjusted OR, 2.13 [95% CI, 1.45–3.13]), and a reduction in restricted antibiotic usage (adjusted OR, 0.38 [95% CI, .27–.54]). In the propensity score analysis, there was an increase in narrow-spectrum penicillins (OR, 10.89 [95% CI, 5.09–23.31]) and β-lactam/β-lactamase inhibitors (OR, 6.68 [95% CI, 3.94–11.35]) and a reduction in restricted antibiotic use (OR, 0.52 [95% CI, .36–.74]) and inappropriate prescriptions (relative risk ratio, 0.43 [95% CI, .26–.72]) in the delabeled group compared with the group who retained their allergy label.
Conclusions
This health services program using a combination of direct delabeling and oral penicillin challenge resulted in significant impacts on the use of preferred antibiotics and appropriate prescribing.
Details
- Title
- The penicillin allergy delabeling program: A Multicenter Whole-of-Hospital health services intervention and comparative effectiveness study
- Authors/Creators
- K.Y.L. Chua (Author/Creator)S. Vogrin (Author/Creator)S. Bury (Author/Creator)A. Douglas (Author/Creator)N.E. Holmes (Author/Creator)N. Tan (Author/Creator)N.K. Brusco (Author/Creator)R. Hall (Author/Creator)B. Lambros (Author/Creator)J. Lean (Author/Creator)W. Stevenson (Author/Creator)M. Devchand (Author/Creator)K. Garrett (Author/Creator)K. Thursky (Author/Creator)M.L. Grayson (Author/Creator)M.A. Slavin (Author/Creator)E.J. Phillips (Author/Creator)J.A. Trubiano (Author/Creator)
- Publication Details
- Clinical Infectious Diseases, Vol.73(3), pp.487-496
- Publisher
- Oxford University Press
- Identifiers
- 991005542028607891
- Copyright
- © 2020 Oxford University Press
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.265 Dermatology - Skin Allergies
- 1.265.1140 Drug Hypersensitivity
- Web Of Science research areas
- Immunology
- Infectious Diseases
- Microbiology
- ESI research areas
- Immunology