Department of Infectious Diseases, Austin Health, Heidelberg.
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria Comprehensive Cancer Centre (VCCC).
Clin Infect Dis. 2017 Jul 1;65(1):166-174. doi: 10.1093/cid/cix244.
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.
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).
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.
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.
尽管患者报告的抗生素过敏（所谓的抗生素过敏标签 [AAL]）患病率很高，且其对抗生素处方的影响很大，但抗生素过敏检测（AAT）纳入抗菌药物管理（AMS）计划（AAT-AMS）的情况并不普遍。我们旨在评估 AAT-AMS 计划对 AAL 患病率、抗生素使用情况以及处方合理性的影响。
2015 年 5 月开始，在澳大利亚的两家大型医院实施 AAT-AMS，为期 14 个月。记录每位参与者在测试前 12 个月（AAT-AMS 前）和测试后 3 个月（AAT-AMS 后）的基线人口统计学、AAL 病史、年龄调整 Charlson 合并症指数、感染史和抗生素使用情况。研究结果包括被“去标签”的 AAL 患者比例、AAT-AMS 前后抗生素治疗方案的范围以及抗生素的适宜性（使用标准定义）。
在 118 例接受抗生素过敏检测的患者中，报告了 226 例 AAL（平均每位患者 1.91 例），其中 53.6%涉及 1 种或多种青霉素类药物。AAT-AMS 使 98 例（83%）患者的 AAL 得以“去标签”，其中 56%（55/98）患者的所有 AAL 均被去除。AAT-AMS 后，窄谱青霉素类药物的处方更有可能（调整后的优势比 [aOR]，2.81；95%置信区间 [CI]，1.45-5.42），窄谱β-内酰胺类药物（aOR，3.54；95%CI，1.98-6.33）和适当的抗生素（aOR，12.27；95%CI，5.00-30.09）也更有可能；而限制类抗生素的处方更不可能（aOR，0.16；95%CI，0.09-0.29），这是在调整了适应证、Charlson 合并症指数和治疗环境因素后的结果。
综合的 AAT-AMS 计划在 AAL 去标签和促进改善抗生素使用和适宜性方面均有效，支持将 AAT 常规纳入 AMS 计划。
