Tan N, Holmes N E, Chua K Y, Stewardson A J, Trubiano J A
Department of Infectious Diseases and Centre for Antibiotic Allergy and Research, Austin Hospital, VIC, Melbourne, Australia.
Department of Infectious Diseases, Alfred Health and Central Clinical School, Monash University, VIC, Melbourne, Australia.
JAC Antimicrob Resist. 2019 Oct 22;1(2):dlz058. doi: 10.1093/jacamr/dlz058. eCollection 2019 Sep.
To define the long-term impacts of antibiotic allergy testing (AAT) on patient allergy perception and antibiotic utilization.
Patients were identified from a prospective AAT database as having completed testing during a 15 month period beginning January 2017. Patients were contacted for a follow-up survey at least 12 months post-AAT. For those contacted, baseline demographics, antibiotic allergy label (AAL) history, age-adjusted Charlson comorbidity index, infection history, antibiotic de-labelling (≥1 AAL removed following AAT) and antibiotic usage for 12 months prior to testing (pre-AAT) and 12 months following testing (post-AAT) were recorded for each patient.
From the follow-up survey of 112 patients post-AAT, 95.2% (59/62) of patients with complete AAL removal expressed willingness to use 'de-labelled' antibiotics and 91.9% (57/62) were adherent to allergy label modification. Comparing antibiotic utilization 12 months pre-AAT versus 12 months post-AAT, AAT was associated with a significant increase in preferred antibiotic therapy [adjusted odds ratio (aOR) 3.29, 95% CI 1.56-6.92] and reduction in restricted antibiotic utilization (aOR 0.42, 95% CI 0.19-0.93).
An antimicrobial stewardship (AMS)-led AAT programme was safe and effective in the long term in the promotion of preferred and narrow-spectrum antibiotic usage, and favourable patient perception towards the AAT testing results was identified. This study further supports the routine incorporation of AAT into AMS programmes, confirming safety and durability of testing impacts on patients as well as increasing preferred antibiotic utilization.
确定抗生素过敏检测（AAT）对患者过敏认知及抗生素使用的长期影响。
从一个前瞻性AAT数据库中识别出在2017年1月开始的15个月期间完成检测的患者。在AAT后至少12个月对患者进行随访调查。对于被联系到的患者，记录每位患者的基线人口统计学信息、抗生素过敏标签（AAL）病史、年龄校正的Charlson合并症指数、感染史、抗生素去标签情况（AAT后去除≥1个AAL）以及检测前12个月（AAT前）和检测后12个月（AAT后）的抗生素使用情况。
在对112例AAT后的患者进行随访调查中，完全去除AAL的患者中有95.2%（59/62）表示愿意使用“去标签”抗生素，91.9%（57/62）遵守过敏标签修改。比较AAT前12个月与AAT后12个月的抗生素使用情况，AAT与首选抗生素治疗的显著增加相关[调整优势比（aOR）3.29，95%可信区间1.56 - 6.92]，且限制抗生素使用减少（aOR 0.42，95%可信区间0.19 - 0.93）。
由抗菌药物管理（AMS）主导的AAT计划在长期内安全有效，可促进首选和窄谱抗生素的使用，且患者对AAT检测结果的认知良好。本研究进一步支持将AAT常规纳入AMS计划，证实了检测对患者影响的安全性和持续性，以及增加首选抗生素的使用。
