Impact of an integrated antibiotic allergy testing program on antimicrobial stewardship: a multicenter evaluation.
Open accessAbstract
Background: Despite the high prevalence of patient-reported antibiotic allergy (so-called antibiotic allergy labels [AALs]) and their impact on antibiotic prescribing, incorporation of antibiotic allergy testing (AAT) into antimicrobial stewardship (AMS) programs (AAT-AMS) is not widespread. We aimed to evaluate the impact of an AAT-AMS program on AAL prevalence, antibiotic usage, and appropriateness of prescribing. Methods: AAT-AMS was implemented at two large Australian hospitals during a 14-month period beginning May 2015. Baseline demographics, AAL history, age-adjusted Charlson comorbidity index, infection history, and antibiotic usage for 12 months prior to testing (pre-AAT-AMS) and 3 months following testing (post-AAT-AMS) were recorded for each participant. Study outcomes included the proportion of patients who were "de-labeled" of their AAL, spectrum of antibiotic courses pre- and post-AAT-AMS, and antibiotic appropriateness (using standard definitions). Results: From the 118 antibiotic allergy-tested patients, 226 AALs were reported (mean, 1.91/patient), with 53.6% involving 1 or more penicillin class drug. AAT-AMS allowed AAL de-labeling in 98 (83%) patients-56% (55/98) with all AALs removed. Post-AAT, prescribing of narrow-spectrum penicillins was more likely (adjusted odds ratio [aOR], 2.81, 95% confidence interval [CI], 1.45-5.42), as was narrow-spectrum β-lactams (aOR, 3.54; 95% CI, 1.98-6.33), and appropriate antibiotics (aOR, 12.27; 95% CI, 5.00-30.09); and less likely for restricted antibiotics (aOR, 0.16; 95% CI, .09-.29), after adjusting for indication, Charlson comorbidity index, and care setting. Conclusions: An integrated AAT-AMS program was effective in both de-labeling of AALs and promotion of improved antibiotic usage and appropriateness, supporting the routine incorporation of AAT into AMS programs.
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Penicillin skin testing has become a clinically significant element in antibiotic stewardship programs, and the procedure has been increasingly used by hospital-based pharmacists, hospitalists, and infectious disease physicians as part of overall antibiotic stewardship interventions.
“Penicillin skin testing has become a clinically significant element in antibiotic stewardship programs, and the procedure has been increasingly used by hospital-based pharmacists, hospitalists, and infectious disease physicians (670,672,673,678,679) as part of overall antibiotic stewardship interventions.”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [670]
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Experimental — accuracy not yet measuredIn hospitalized patients and other populations with comorbidities, the typical rates of validated penicillin allergy among patients who report a history of penicillin allergy are 2.5%-9.0%.
“In hospitalized patients and other populations with comorbidities, the typical rates of validated penicillin allergy among patients who report a history of penicillin allergy are 2.5%–9.0% (670–673).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [670]
The Discussion reports that testing removed 85% of penicillin allergy labels, supporting the point that many reported allergies were not validated. It does not give a validated-allergy rate of 2.5%–9.0% or establish that range as typical across hospitalized patients and other populations with comorbidities. (LLM, conf=0.84)
Experimental — accuracy not yet measuredWhen integrated into stewardship, the rates of ß-lactam antibiotic use increased substantially.
“When integrated into stewardship, the rates of ß-lactam antibiotic use increased substantially (670).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [670]
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- Authors
- Trubiano, J. A., Thursky, K. A., Stewardson, A. J., Urbancic, K., Worth, L. J., Jackson, C., Stevenson, W., Sutherland, M., Slavin, M. A., Grayson, M. L., & Phillips, E. J.
- Affiliations
- The University of Melbourne (AU)
- The Royal Melbourne Hospital (AU)
- Austin Health (AU)
- Peter MacCallum Cancer Centre (AU)
- Murdoch University (AU)
- Corresponding author
- Trubiano, Jason A
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-05-18
- Volume
- 65
- Issue
- 1
- Pages
- 166-174
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC5849110
- OpenAlex
- W2615507425
- Cited by
- 137
- References
- 48
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 17 · 2023: 18 · 2022: 21 · 2021: 11 · 2020: 15 · 2019: 22 · 2018: 16 · 2017: 1
- FWCI
- 11.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Murdoch University Research Portal (submittedVersion)
- Funders
- National Institutes of Health (1P50GM115305-01, 1R01AI103348-01, P30 AI110527, 1R13 AR071267-01)
- National Health and Medical Research Council
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- antibiotic allergy testing, antimicrobial stewardship, delabeling, penicillin allergy, antibiotic prescribing appropriateness, narrow-spectrum antibiotics, beta-lactam antibiotics, restricted antibiotics, hospital antibiotic use
- MeSH terms
- Antimicrobial Stewardship, Aged, Anti-Bacterial Agents, Australia, Drug Hypersensitivity, Female, Hospitals, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Penicillins, Skin Tests, Inappropriate Prescribing, Drug-Related Side Effects and Adverse Reactions
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