Chakravorty Arindam, Binder Elene, Rawlins Matthew, Trevenen Michelle, Ingram Paul R, McKeogh Anna, Murray Kevin, Dyer John, Lucas Michaela
Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Department of Pharmacy, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Intern Med J. 2022 Mar;52(3):396-402. doi: 10.1111/imj.15003.
Although common, antimicrobial allergy labels (AAL) rarely reflect immunologically-mediated hypersensitivity and can lead to poorer outcomes from alternative antimicrobial agents. Antimicrobial stewardship programs are ideally placed to assess AAL early as a means of improving antimicrobial use.
To quantify the prevalence of AAL in patients referred for antimicrobial stewardship review and assess their impact on antibiotic prescribing, patient mortality, hospital length of stay, readmission and rates of multidrug-resistant infections.
We conducted a retrospective analysis of adult patients referred for inpatient antimicrobial prospective audit and feedback rounds (PAFR) through an electronic referral system (eReferrals) over a 12-month period in 2015. Outcome data were collected for a period of 36 months following the initial review.
Of the 639 patient records reviewed, 630 met inclusion criteria; 103 (16%) had an AAL, of which 82 (13%) had reported allergies to β-lactam antibiotics. Those with AAL were significantly less likely to be receiving guideline-recommended antimicrobial therapy (50% vs 64%, P = 0.0311); however, there were no significant difference in mortality, hospital length of stay, readmission or increased incidence of multidrug-resistant infections.
Our cohort demonstrated that AAL was associated with reduced adherence to antibiotic guidelines. The lack of association with adverse outcomes may reflect limitations within the study including retrospective cohort study numbers and observational nature, further skewed by high rates of poor documentation. A clear opportunity exists for antimicrobial stewardship programs to incorporate allergy assessment, de-labelling, challenge and referral into these rounds.
抗菌药物过敏标签（AAL）虽然常见，但很少反映免疫介导的超敏反应，并且可能导致使用替代抗菌药物时出现更差的结果。抗菌药物管理计划处于理想位置，可以尽早评估AAL，以此作为改善抗菌药物使用的一种方式。
量化转诊接受抗菌药物管理审查的患者中AAL的患病率，并评估其对抗生素处方、患者死亡率、住院时间、再入院率和多重耐药感染率的影响。
我们对2015年通过电子转诊系统（电子转诊）转诊接受住院患者抗菌药物前瞻性审计和反馈轮次（PAFR）的成年患者进行了回顾性分析。在初次审查后的36个月内收集结果数据。
在审查的639份患者记录中，630份符合纳入标准；103份（16%）有AAL，其中82份（13%）报告对β-内酰胺类抗生素过敏。有AAL的患者接受指南推荐的抗菌治疗的可能性显著降低（50%对64%，P = 0.0311）；然而，在死亡率、住院时间、再入院率或多重耐药感染发生率增加方面没有显著差异。
我们的队列研究表明，AAL与抗生素指南依从性降低有关。与不良结局缺乏关联可能反映了研究中的局限性，包括回顾性队列研究数量和观察性质，因记录不佳的高发生率而进一步扭曲。抗菌药物管理计划有明显机会将过敏评估、去除标签、激发试验和转诊纳入这些轮次。
