Gaberino Courtney L, Chiu Asriani M, Mahatme Sheran S
Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.
Medical College of Wisconsin, Milwaukee, Wisconsin; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Division of Asthma, Allergy, and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Ann Allergy Asthma Immunol. 2022 Mar;128(3):307-313. doi: 10.1016/j.anai.2021.12.004. Epub 2021 Dec 7.
Beta-lactam antibiotic allergy labels are highly prevalent but rarely indicate an allergic intolerance. These patient-reported allergies lead to broad-spectrum antibiotic use, conferred resistance, increased expense, and adverse effects.
To implement and assess the impact of a history-based clinical guideline that directs antibiotic management and beta-lactam allergy relabeling for patients reporting beta-lactam allergies.
Patients with beta-lactam allergy labels were identified by our trained multidisciplinary team in diverse clinical settings. This quality improvement project was conducted to evaluate the safety and impact of the guideline on antibiotic use by comparing prescribing practices before and after guideline implementation.
A total of 79 patients with beta-lactam allergies were identified (penicillins-90%, cephalosporins-10%). After guideline implementation, outcomes of allergy relabeling included the following: (1) complete removal, indicating an unlikely true allergy (27%); (2) updated to detail successfully tolerated beta-lactam courses (48%); or (3) no change made to current label (25%). Beta-lactam antibiotic courses before and after guideline implementation compared with total antibiotic courses: allergy removed (44% vs 70%; P < .001), allergy updated (32% vs 68%; P < .001), and no change (27% vs 41%; P = .08). Compared with before guideline implementation, beta-lactam antibiotics were 3 times more likely to be prescribed after allergy assessment (odds ratio, 3.22; 95% confidence interval, 2.4-4.3; P < .05).
The implementation of the beta-lactam allergy clinical guideline resulted in most patients' allergy labels being removed or advantageously updated. These allergy label changes correlated with a substantial increase in the percentage of beta-lactam antibiotics prescribed. After guideline implementation, beta-lactam antibiotics had a 3-fold increased odds of being prescribed independent of allergy label outcome.
β-内酰胺类抗生素过敏标签极为常见，但极少表明存在过敏不耐受情况。这些患者自述的过敏反应导致了广谱抗生素的使用、耐药性产生、费用增加以及不良反应。
实施一项基于病史的临床指南，并评估其对报告有β-内酰胺类过敏的患者进行抗生素管理和β-内酰胺类过敏重新标注的影响。
由我们训练有素的多学科团队在不同临床环境中识别出有β-内酰胺类过敏标签的患者。通过比较指南实施前后的处方实践，开展了这项质量改进项目，以评估该指南对抗生素使用的安全性和影响。
共识别出79例有β-内酰胺类过敏的患者（青霉素类占90%，头孢菌素类占10%）。指南实施后，过敏重新标注的结果如下：（1）完全去除，表明不太可能是真正的过敏（27%）；（2）更新以详细说明成功耐受的β-内酰胺类疗程（48%）；或（3）当前标签未改变（25%）。指南实施前后β-内酰胺类抗生素疗程与总抗生素疗程的比较：过敏去除（44%对70%；P<.001），过敏更新（32%对68%；P<.001），无变化（27%对41%；P=.08）。与指南实施前相比，过敏评估后开具β-内酰胺类抗生素的可能性增加了3倍（比值比，3.22；95%置信区间，2.4 - 4.3；P<.05）。
β-内酰胺类过敏临床指南的实施使得大多数患者的过敏标签被去除或得到有利更新。这些过敏标签的变化与β-内酰胺类抗生素处方百分比的大幅增加相关。指南实施后，无论过敏标签结果如何，开具β-内酰胺类抗生素的几率增加了3倍。
