Antimicrobial allergy ‘labels’ drive inappropriate antimicrobial prescribing: lessons for stewardship

Trubiano, Jason A; Chen, C.; Cheng, AC; Grayson, M. Lindsay; Slavin, Monica A; Thursky, Karin

doi:10.1093/jac/dkw008

Cited by 104 publications

(120 citation statements)

References 21 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, patients with registration of Pen-A use more primary health care. Remarkably, in contrast to previous studies [11, 14, 23] Pen-A patients did not receive less prescriptions of penicillins compared to non-Pen-A patients in our study. Possible explanation could be that prescribing GPs in our study were aware of the overestimation of Pen-A labeling and consciously prescribed penicillins to Pen-A patients based on their own experience.…”

Section: Discussioncontrasting

confidence: 99%

See 1 more Smart Citation

The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study

Broekhuizen

Verheij

et al. 2017

Clin Transl Allergy

View full text Add to dashboard Cite

BackgroundSuspected penicillin allergy (Pen-A) is often not verified by diagnostic testing. In third line penicillin allergy labels were associated with prescription of broad spectrum antibiotics, hospital stay duration and readmission.ObjectiveAssess the impact of Pen-A labels on antibiotic and health care use in primary care.MethodsA retrospective cohort study was conducted in primary care in the Utrecht area, the Netherlands. All patients registered with a penicillin allergy on 31 December 2013 were selected from the General Practitioner Network database. Each patient with a Pen-A label was matched for age, gender, follow-up period with three patients without Pen-A label. Risk (OR) of receiving a reserve and second choice antibiotic, number and type of antibiotics prescribed during follow-up and number of GP contacts were compared between the two cohorts.ResultsOf 196,440 patients, 1254 patients (0.6%) with a Pen-A label were identified and matched with 3756 patients without Pen-A label. Pen-A labels resulted in higher risk of receiving ≥1 antibiotic prescription per year (OR 2.56, 95% CI 2.05–3.20), ≥1 s choice antibiotic prescription per year (OR 2.21 95% CI 1.11–4.40), and ≥4 GP contacts per year (OR 1.71 95% CI 1.46–2.00). The chance of receiving tetracyclins (OR 2.24, 95% CI 1.29–3.89), macrolides/lincosamides/streptogamins (OR 8.69, 95% CI 4.26–17.73) and quinolones (OR 2.59, 95% CI 1.22–5.48) was higher in Pen-A patients.ConclusionsIn primary health care Pen-A labels are associated with increased antibiotic use, including second choice antibiotics, and more health care use.Electronic supplementary materialThe online version of this article (doi:10.1186/s13601-017-0154-y) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussioncontrasting

confidence: 99%

“…However, considering the fact that most allergy labels are incorrect, the prescribing of beta-lactam antibiotics in our population was incorrectly avoided in most cases. Considering the emerge of antimicrobial resistance, efforts to decrease incorrect labeling are worthwhile [23]. …”

Section: Discussionmentioning

confidence: 99%

The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study

Broekhuizen

Verheij

et al. 2017

Clin Transl Allergy

View full text Add to dashboard Cite

show abstract

“…Recent studies have highlighted increased use of restricted antibiotics and inappropriate prescriptions in those with antibiotic allergy labels [2]. The engagement of hospital pharmacists is essential; programs using direct allergy referrals from pharmacy departments have aided delabeling initiatives [12, 20].…”

Section: Discussionmentioning

confidence: 99%

Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network

Trubiano

Beekmann

Worth

et al. 2016

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Antibiotic allergy testing (AAT) practices of Emerging Infections Network infectious disease physicians were surveyed. Although AAT was perceived to be necessary for removal of inappropriate or unnecessary allergy labels, there was limited access to any form of testing. In this study, we discuss current antibiotic allergy knowledge gaps and the development of AAT practices within antimicrobial stewardship programs, which will potentially improve antimicrobial prescribing.

show abstract

“…P atient-reported antibiotic allergies (so-called antibiotic allergy labels [AALs]) are associated with suboptimal prescribing and inferior clinical outcomes, especially in the immunocompromised (1,2). The prevalence, type, and impact of AALs in liver transplant recipients (LTRs) remain ill defined.…”

mentioning

confidence: 99%

Antibiotic Allergy Labels in a Liver Transplant Recipient Study

Khumra

Chan

Urbancic

et al. 2017

Antimicrob Agents Chemother

Self Cite

View full text Add to dashboard Cite

P atient-reported antibiotic allergies (so-called antibiotic allergy labels [AALs]) are associated with suboptimal prescribing and inferior clinical outcomes, especially in the immunocompromised (1, 2). The prevalence, type, and impact of AALs in liver transplant recipients (LTRs) remain ill defined. We report on AALs and their impact on a cohort of Australian LTRs.A retrospective matched-cohort study was conducted over a 5-year period (2010 to 2015) at an Australian liver transplant center (Austin Health). Using a departmental liver transplant database, LTRs with an AAL (AAL group) were identified. The same number of matched controls (LTRs without an antibiotic allergy label [non-AAL group]) were randomly selected for comparison. AALs were evaluated and classified as type A adverse drug reactions (ADRs; nonimmune mediated), type B ADRs (immune mediated), or of unknown type (3). Baseline demographics, transplant history, and infection-related admission data were collected. From the time of transplant until 12 months afterward, antibiotics administered during infection-related admissions and their duration of administration were recorded. Readmission, intensive-care unit (ICU) admission, Clostridium difficile infection (CDI), multidrug-resistant (MDR) organism isolation, and mortality rate were captured. An MDR organism was defined as a bacterium resistant to at least one agent in three or more antibiotic classes (4).Of 313 LTRs, 51 (16%) had Ն1 AAL. Females predominated in the AAL group (75% female versus 25% male; P ϭ 0.003), but there was no statistically significant differences in the rates of ICU admission and mortality between males and females (see Table S1 in the supplemental material). Seventy-seven AALs were recorded; of these, 23% (18/77) were type A ADRs, 66% were type B ADRs (51/77), and 10% (8/77) were of unknown type. Of the type A ADRs, 72% (13/18) were gastrointestinal upset, and of the type B ADRs, 6% (3/51) were severe cutaneous ADRs, 55% (28/51) were maculopapular exanthema, 35% (18/51) were anaphylaxis, urticaria, or angioedema, and 4% (2/51) were other reactions. The antibiotics implicated in AALs are demonstrated in Fig. 1

show abstract

Antimicrobial allergy ‘labels’ drive inappropriate antimicrobial prescribing: lessons for stewardship

Cited by 104 publications

References 21 publications

The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study

The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study

Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network

Antibiotic Allergy Labels in a Liver Transplant Recipient Study

Contact Info

Product

Resources

About