Beta-lactam Administration Patterns at a Safety-net Hospital with Limited Access to Inpatient Penicillin Skin Testing

Abstract

RATIONALE: Inaccurate beta-lactam allergy (BLA) labeling is associated with worse clinical outcomes due to over-avoidance of beta-lactam antibiotics. Although BLA de-labeling with penicillin skin testing (PST) can increase beta-lactam use, it is not readily available at many hospitals. There is a need to assess beta-lactam administration patterns at hospitals without readily available PST to identify potential areas for improvement. METHODS: Admission records of 282 patients with listed BLA who required antibiotics during hospitalization between June 2017 and July 2018 at a safety-net hospital with limited access to inpatient PST were reviewed retrospectively. RESULTS: Full doses of beta-lactams were administered without reaction in 73.0% [157/215] of patients with documented penicillin allergy (PA). Penicillin antibiotics were administered in 15.8% [34/215], 1st-generation cephalosporins in 11.6% [25/215], 2nd-generation cephalosporins in 0% [0/215], 3rd-generation cephalosporins in 26.5% [57/215], and 4th-generation cephalosporins in 20.0% [43/215]. The 34 patients who received penicillin antibiotics had the following documented reactions: other 50.0% [17/34], hives 17.6% [6/34], rash 17.6% [6/34], anaphylaxis 5.9% [2/34], shortness of breath and swelling 2.9% [1/34], not documented 2.9% [1/34], and fatigue 2.9% [1/34]. Conversely, of 13 patients with documented allergy to 3rd/4th/5th-generation cephalosporins, 38.5% [5/13] received full doses of a penicillin antibiotic without reaction.CONCLUSIONS: Beta-lactam administration was higher than expected, with full doses of penicillin and cephalosporin antibiotics administered without reaction in many patients with documented PA, including patients with documented penicillin anaphylaxis. Further investigation is needed into provider beliefs surrounding BLA cross-reactivity and the role of PST at this hospital, and their impact on beta-lactam administration practices. Abstracts AB31 SATURDAY