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Utilization and timeliness of an inpatient penicillin allergy evaluation

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Background:

A history of penicillin allergy is associated with an increased risk of nosocomial infections because patients are exposed to non‐beta lactam antibiotics. Ruling out inaccurate penicillin allergy during hospitalization decreases prescription of beta lactam antibiotics. However, the utilization of penicillin allergy testing and timeliness in relation to initiation of antibiotics is not known.

Objective:

Our aim was to describe the proportion and characteristics of patients who underwent inpatient penicillin allergy testing in a hospital without a guideline or infrastructure for inpatient penicillin allergy testing.

Methods:

We performed a retrospective chart review of patients admitted to our institution between January 1, 2008, and December 31, 2015, who underwent penicillin allergy testing.

Results:

Forty-nine patients were identified; 27 (55.1%) were women. The median age was 61.5 years (interquartile range [IQR], 48.5‐71 years). The median Charlson-Comorbidity index score was 4 (IQR, 2‐5.5). Of these patients, 42.86% (21) were admitted to the intensive care unit, 79.6% of allergy consults were requested by infectious disease physicians, and 87.8% of patients were receiving non‐beta lactam antibiotics at the time of testing. The patients received a median of 5 days of antibiotics before testing (range, 0‐16 days; IQR, 3‐7 days). Antimicrobial therapy was changed in 78.0% of the patients (32), of whom 68.3% (21/32) was attributable to penicillin allergy testing.

Conclusion:

Inpatient penicillin allergy testing is a critical component of antibiotic stewardship; however, an adequate infrastructure is essential for timely evaluation. Inpatient penicillin allergy evaluation requires a multidisciplinary approach focused on patient selection; risk stratification; and optimization of a timely, safe, and cost-effective approach to optimize patient outcomes.
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Keywords: Antimicrobial stewardship; drug allergy; hospitalization; inpatient; penicillin allergy; penicillin testing; value care

Document Type: Research Article

Affiliations: 1: From the Department of Medicine, Mayo Clinic, Jacksonville, Florida 2: Division of Infectious Disease, Mayo Clinic, Jacksonville, Florida 3: Division of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida 4: Division of Allergy and Immunology, Mayo Clinic, Rochester, Minnesota 5: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota

Publication date: May 1, 2018

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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