Point-of-care β-lactam allergy skin testing by antimicrobial stewardship programs: a pragmatic multicenter prospective evaluation.
Abstract
Background: β-lactam allergy skin testing (BLAST) is recommended by antimicrobial stewardship program (ASP) guidelines, yet few studies have systematically evaluated its impact when delivered at point of care. Methods: We conducted a pragmatic multicenter prospective evaluation of the use of point-of-care BLAST by ASPs. In staggered 3-month intervals, ASP teams at 3 hospitals received training by allergists to offer BLAST for eligible patients with infectious diseases receiving nonpreferred therapy due to severity of their reported allergy. The primary outcome was the proportion of patients receiving the preferred β-lactam therapy. Results: Of 827 patients with reported β-lactam allergy over 15 months, β-lactam therapy was preferred among 632 (76%). During baseline periods, 50% (124/246) received preferred β-lactam therapy based on history, compared with 60% (232/386) during the intervention periods (P = .02), which improved further to 81% (313/386) upon provision of BLAST (P < .001) without any increase in incidence of adverse drug reactions (4% vs 3%; P = .4). After adjusting for patient variables and the correlation between hospitals, the intervention period was associated with a 4.5-fold greater odds of receiving preferred β-lactam therapy (95% confidence interval, 2.4-8.2; P < .0001). Conclusions: The use of BLAST at the point of care across 3 hospital ASPs resulted in greater use of preferred β-lactam therapy without increasing the risk of adverse drug reactions. Longer-term studies are needed to better assess the safety and clinical impact of this ASP intervention.
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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%.
“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 [673]
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 [673]
Cites
Barlam, T. F., Cosgrove, S. E., Abbo, L. M., MacDougall, C., Schuetz, A. N., Septimus, E. J., Srinivasan, A., Dellit, T. H., Falck-Ytter, Y. T., Fishman, N. O., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw118 · Cited by 3,147 · see citing works
Macy, E., & Contreras, R. (2014) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.09.021 · Cited by 829 · see citing works
Sogn, D. D. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400170105020 · Cited by 337 · see citing works
Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study
MacFadden, D. R., Delfa, A. L., Leen, J., Gold, W. L., Daneman, N., Weber, E., Al-Busaidi, I. S., Petrescu, D., Saltzman, I., Devlin, M. K., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw462 · Cited by 297 · see citing works
Self-citationMcDanel, J. S., Perencevich, E. N., Diekema, D. J., Herwaldt, L. A., Smith, T. C., Chrischilles, E. A., Dawson, J. D., Jiang, L., Goto, M., & Schweizer, M. L. (2015) · Clinical Infectious Diseases · doi:10.1093/cid/civ308 · Cited by 225 · see citing works
Blumenthal, K. G., Shenoy, E. S., Varughese, C. A., Hurwitz, S., Hooper, D. C., & Banerji, A. (2015) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2015.05.011 · Cited by 185 · see citing works
Charneski, L., Deshpande, G., & Smith, S. W. (2011) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.31.8.742 · Cited by 182 · see citing works
A proactive approach to penicillin allergy testing in hospitalized patients.
Chen, J. R., Tarver, S. A., Alvarez, K. S., Tran, T., & Khan, D. A. (2017) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2016.09.045 · Cited by 152 · see citing works
Tackling inpatient penicillin allergies: Assessing tools for antimicrobial stewardship
Blumenthal, K. G., Wickner, P. G., Hurwitz, S., Pricco, N., Nee, A. E., Laskowski, K. R., Shenoy, E. S., & Walensky, R. P. (2017) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2017.02.005 · Cited by 146 · see citing works
The impact of penicillin skin testing on clinical practice and antimicrobial stewardship
Rimawi, R. H., Cook, P., Gooch, M. D., Kabchi, B. A., Ashraf, M. S., Rimawi, B. H., Gebregziabher, M., & Siraj, D. S. (2013) · Journal of Hospital Medicine · doi:10.1002/jhm.2036 · Cited by 141 · see citing works
Macy, E. M., Mangat, R., & Burchette, R. J. (2003) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2003.1385 · Cited by 120 · see citing works
Blumenthal, K. G., Shenoy, E. S., Huang, M., Kuhlen, J. L., Ware, W., Parker, R. A., & Walensky, R. P. (2016) · PLoS ONE · doi:10.1371/journal.pone.0159406 · Cited by 94 · see citing works
Blumenthal, K. G., Parker, R. A., Shenoy, E. S., & Walensky, R. P. (2015) · Clinical Infectious Diseases · doi:10.1093/cid/civ394 · Cited by 89 · see citing works
Penicillin Skin Testing: Potential Implications for Antimicrobial Stewardship
Unger, N. R., Gauthier, T. P., & Cheung, L. (2013) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.1288 · Cited by 79 · see citing works
Arroliga, M. E., Radojicic, C., Gordon, S. M., Popovich, M. J., Bashour, C. A., Melton, A. L., & Arroliga, A. C. (2003) · Infection Control and Hospital Epidemiology · doi:10.1086/502212 · Cited by 69 · see citing works
Leis, J. A., Evans, G. A., Ciccotelli, W. A., et al. (2016) · Journal of the Association of Medical Microbiology and Infectious Disease Canada · doi:10.3138/jammi.1.1.02 · Cited by 3 · see citing works
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
Evaluation and Management of Penicillin Allergy: A Review
Shenoy, E. S., Macy, E., Rowe, T., & Blumenthal, K. G. (2019) · JAMA · doi:10.1001/jama.2018.19283 · Cited by 830 · see citing works
- Authors
- Leis, J. A., Palmay, L., Ho, G., Raybardhan, S., Gill, S., Kan, T., Campbell, J., Kiss, A., McCready, J. B., Das, P., Minnema, B., Powis, J. E., Walker, S. A. N., Ferguson, H., Wong, B., & Weber, E.
- Affiliations
- Sunnybrook Research Institute (CA)
- Sunnybrook Health Science Centre (CA)
- Toronto East General Hospital (CA)
- North York General Hospital (CA)
- University of Toronto (CA)
- Corresponding author
- Leis, Jerome A
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-06-01
- Volume
- 65
- Issue
- 7
- Pages
- 1059-1065
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2621358797
- Cited by
- 59
- References
- 16
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 2 · 2022: 6 · 2021: 6 · 2020: 7 · 2019: 16 · 2018: 10 · 2017: 1
- FWCI
- 7.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- 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
- antimicrobial stewardship programs, point-of-care testing, beta-lactam allergy, adverse drug reactions, infection treatment
- MeSH terms
- Point-of-Care Testing, Antimicrobial Stewardship, Aged, Aged, 80 and over, Anti-Bacterial Agents, Drug Hypersensitivity, Female, Hospitals, Humans, Male, Middle Aged, Prospective Studies, Skin Tests, beta-Lactams, Drug-Related Side Effects and Adverse Reactions
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