Multicenter Australian Study to Determine Criteria for Low- and High-Risk Penicillin Testing in Outpatients

Stevenson, Brittany; Trevenen, Michelle; Klinken, Elizabeth; Smith, William B.; Yuson, Carlo; Katelaris, Constance H.; Perram, Fiona; Burton, Pamela; Yun, James; Cai, Fenfen; Barnes, Sara; Spriggs, Kymble; Ojaimi, Samar; Mullins, Raymond J; Salman, Sam; Martínez, Patricia; Murray, Kevin; Lucas, Michaela

doi:10.1016/j.jaip.2019.09.025

Cited by 43 publications

(24 citation statements)

References 27 publications

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“…22 A distant benign rash was reported in over a third of cohort patients, representing significant opportunity for assessment, supervised re-challenge and subsequent delabelling in the majority of cases. [23][24][25] AAL in our cohort was associated with significantly lower use of penicillin (34% vs 83%), and increase in use of alternative agents; with 3-fold increase in the prescription of cephalosporins (38% vs 11%), lincosamides (9% vs 3%) and 4-fold increase in the prescription of quinolones (20% vs 5%) and nitroimidazoles (29% vs 7%). Utilising recommendations from the Australian Therapeutic Guidelines: Antibiotic (eTG v15 2016), 15 the use of guideline-recommended therapy for the entire examined cohort was low (62%), with recommended therapy prescribed significantly less for patients with AAL (50%) than those without (64%).…”

Section: Discussionmentioning

confidence: 68%

Antibiotic allergy labels and optimal antimicrobial stewardship

Chakravorty

Binder²,

Rawlins³

et al. 2022

Internal Medicine Journal

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Background: Although common, antimicrobial allergy labels (AAL) rarely reflect immunologically-mediated hypersensitivity and can lead to poorer outcomes from alternative antimicrobial agents. Antimicrobial stewardship programs are ideally placed to assess AAL early as a means of improving antimicrobial use.Aims: To quantify the prevalence of AAL in patients referred for antimicrobial stewardship review and assess their impact on antibiotic prescribing, patient mortality, hospital length of stay, readmission and rates of multidrug-resistant infections.Methods: We conducted a retrospective analysis of adult patients referred for inpatient antimicrobial prospective audit and feedback rounds (PAFR) through an electronic referral system (eReferrals) over a 12-month period in 2015. Outcome data were collected for a period of 36 months following the initial review.Results: Of the 639 patient records reviewed, 630 met inclusion criteria; 103 (16%) had an AAL, of which 82 (13%) had reported allergies to β-lactam antibiotics. Those with AAL were significantly less likely to be receiving guideline-recommended antimicrobial therapy (50% vs 64%, P = 0.0311); however, there were no significant difference in mortality, hospital length of stay, readmission or increased incidence of multidrug-resistant infections.Conclusions: Our cohort demonstrated that AAL was associated with reduced adherence to antibiotic guidelines. The lack of association with adverse outcomes may reflect limitations within the study including retrospective cohort study numbers and observational nature, further skewed by high rates of poor documentation. A clear opportunity exists for antimicrobial stewardship programs to incorporate allergy assessment, delabelling, challenge and referral into these rounds.

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Section: Discussionmentioning

confidence: 68%

Antibiotic allergy labels and optimal antimicrobial stewardship

Chakravorty

Binder²,

Rawlins³

et al. 2022

Internal Medicine Journal

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“…However, a direct amoxicillin exposition is considered to be safe, if more than 10 years have gone since the reaction. 3 However, in an Australian multicenter study, 4 if penicillin-associated rash was over 1 year earlier, a direct challenge was considered safe for low-risk patients, but skin testing for highrisk patients. According to present findings on the case and other cases with positive IgE to antibiotics, amoxicillin exposition may not be reliable in showing immediate allergies for phenoxymethylpenicillin or benzylpenicillin.…”

Section: Discussionmentioning

confidence: 99%

Case: Unexpected development of severe penicillin allergy and review of literature

Harvima

2022

Clinical Case Reports

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“…However, what constitutes a “low-risk” BL allergy history is highly variable. Recently, a multicenter Australian study investigated criteria to determine an optimal low-risk definition for penicillin testing ( Stevenson et al, 2020 ). They evaluated 447 patients and found that 97.1% of 244 patients defined as low risk tolerated a direct OPT ( Stevenson et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a multicenter Australian study investigated criteria to determine an optimal low-risk definition for penicillin testing ( Stevenson et al, 2020 ). They evaluated 447 patients and found that 97.1% of 244 patients defined as low risk tolerated a direct OPT ( Stevenson et al, 2020 ). They concluded that a history of penicillin-associated exanthema (without angioedema, mucosal ulceration, or systemic involvement), more than 1 year ago, was sufficient to select a patient for a direct OPT ( Stevenson et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%