Royal Cornwall Hospitals NHS Trust, Truro, UK; National Institute for Health Research Health Protection Research Unit, Healthcare-associated Infections and Antimicrobial Resistance, Imperial College London, Public Health England, London, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
J Hosp Infect. 2021 Sep;115:10-16. doi: 10.1016/j.jhin.2021.04.011. Epub 2021 Apr 23.
The WHO's AWaRe classification categorizes antibiotics into three stewardship groups: Access, Watch and Reserve. The Access group includes antibiotics with lower resistance potential than antibiotics in the other two groups. The UK five-year AMR strategy has set targets for reducing non-Access antibiotic use. The majority of penicillins are in the Access group and therefore patients with a penicillin allergy record are likely to receive more non-Access antibiotics. This study aimed to quantify the impact of penicillin allergy records on non-Access antibiotic prescribing and to estimate potential reductions in non-Access antibiotic use through penicillin allergy de-labelling.
Inpatients of a 750-patient-bed UK district general hospital in England prescribed antibiotics between 1 April 2018 and 31 March 2019 were included. Variables included: age, sex, co-morbidity, infection treated, antibiotic usage, hospital length of stay, penicillin allergy status. Multivariable logistic regression was used to explore the association between patient characteristics and their receipt of antibiotics in the Access and non-Access groups.
A total of 67,059 antibiotic prescriptions for 23,356 inpatients were analysed. Penicillin allergy records were present in 14.3% of hospital admissions. Patients with a penicillin allergy record were around four times more likely (odds ratio = 4.7) to receive an antibiotic from the non-Access groups (i.e. Reserve and Watch groups). We estimate de-labelling 50% of hospital inpatients with a penicillin allergy record could reduce non-Access antibiotic use by 5.8% and total antibiotic use by 0.86%.
Penicillin allergy records are associated with non-Access antibiotic prescribing. Penicillin allergy de-labelling has potential to reduce non-Access antibiotic use.
世界卫生组织的 AWaRe 分类将抗生素分为三个管理类别：准入、监控和储备。准入组包括比其他两组抗生素耐药潜力更低的抗生素。英国五年抗生素耐药性战略设定了减少非准入抗生素使用的目标。大多数青霉素类抗生素都属于准入组，因此有青霉素过敏记录的患者可能会接受更多的非准入抗生素。本研究旨在量化青霉素过敏记录对非准入抗生素处方的影响，并通过青霉素过敏去标签来估计减少非准入抗生素使用的潜力。
纳入 2018 年 4 月 1 日至 2019 年 3 月 31 日期间在英格兰一家 750 张病床的英国地区综合医院住院的接受抗生素治疗的 23356 名患者。变量包括：年龄、性别、合并症、治疗感染、抗生素使用、住院时间、青霉素过敏状态。多变量逻辑回归用于探讨患者特征与他们在准入和非准入组中接受抗生素治疗的关系。
共分析了 67059 份 23356 名住院患者的抗生素处方。有 14.3%的住院患者有青霉素过敏记录。有青霉素过敏记录的患者接受非准入组（即储备组和监控组）抗生素治疗的可能性约为四倍（比值比=4.7）。我们估计，将 50%的有青霉素过敏记录的住院患者去标签，可以减少 5.8%的非准入抗生素使用和 0.86%的总抗生素使用。
青霉素过敏记录与非准入抗生素处方有关。青霉素过敏去标签有可能减少非准入抗生素的使用。
