Infection Services, Middlemore Hospital, Auckland, New Zealand.
Department of Immunology, Auckland City Hospital, Auckland, New Zealand.
J Antimicrob Chemother. 2019 May 1;74(5):1438-1446. doi: 10.1093/jac/dky575.
Inaccurate allergy labelling results in inappropriate antimicrobial management of the patient, which may affect clinical outcome, increase the risk of adverse events and increase costs. Inappropriate use of alternative antibiotics has implications for antimicrobial stewardship programmes and microbial resistance.
All adult inpatients labelled as penicillin allergic were identified and screened for eligibility by the study pharmacist. An accurate allergy and medication history was taken. Patients were 'de-labelled', underwent oral challenge or were referred to an immunology clinic, if study criteria were met. All patients included in the study were followed-up 1 year after intervention.
Two hundred and fifty eligible patients with a label of 'penicillin allergy' were identified. The prevalence of reported penicillin allergy at Middlemore Hospital was 11%. We found that 80% of study patients could be 'de-labelled'. Of those, 80% were 'de-labelled' after an interview with the pharmacist alone, 16% had an uneventful oral challenge and 4% were deemed to be inappropriately labelled after referral to an immunology clinic. Appropriately labelled patients accounted for 20% of the study population. Changes to inpatient antibiotic therapy were recommended in 61% of 'de-labelled' patients, of which no patients had adverse events after commencing on penicillin antibiotics. At the 1 year follow-up, 98% of patients who were 'de-labelled' had no adverse events to repeated administration of penicillin antibiotics.
This study showed that a pharmacist-led allergy management service is a safe option to promote antimicrobial stewardship and appropriate allergy labelling.
不准确的过敏标签结果会导致患者对抗生素的管理不当，这可能会影响临床结果，增加不良事件的风险，并增加成本。替代抗生素的不当使用对抗菌药物管理计划和微生物耐药性有影响。
研究药剂师通过识别和筛选所有被标记为青霉素过敏的成年住院患者来确定其是否符合入选条件。患者接受了准确的过敏和用药史采集。如果符合研究标准，患者将被“去标签化”，进行口服挑战或转至免疫科诊所。所有纳入研究的患者在干预后 1 年内进行随访。
确定了 250 名符合条件的标签为“青霉素过敏”的患者。米德尔莫尔医院报告的青霉素过敏发生率为 11%。我们发现 80%的研究患者可以“去标签化”。其中，80%的患者仅通过与药剂师面谈“去标签化”，16%的患者口服挑战无不良反应，4%的患者经转至免疫科诊所后被认为是标签不当。适当标签的患者占研究人群的 20%。建议对 61%的“去标签化”患者进行住院抗生素治疗的改变，其中开始使用青霉素抗生素后没有患者出现不良事件。在 1 年的随访中，98%的“去标签化”患者重复使用青霉素抗生素后没有不良事件。
这项研究表明，药剂师主导的过敏管理服务是促进抗菌药物管理和适当过敏标签的安全选择。
