Herrmann Susan, Kulkarni Rishabh, Trevenen Michelle, Karuppasamy Hana, Willis Catherine, Berry Renee, Von Ungern-Sternberg Britta, Warrier Niklesh, Li Ian, Murray Kevin, Lucas Michaela
School of Medicine, The University of Western Australia, Perth, Australia.
Department of Immunology, Sir Charles Gairdner Hospital, Perth, Australia.
J Allergy Clin Immunol Glob. 2024 Aug 21;3(4):100326. doi: 10.1016/j.jacig.2024.100326. eCollection 2024 Nov.
The clinical consequences of an antibiotic allergy label are detrimental, impacting health care delivery and patient outcomes. We assessed hospital inpatients with intent to offer free antibiotic allergy labeling (AAL) assessment within a randomized controlled trial.
We sought to determine the feasibility of establishing an adult antibiotic allergy delabeling service in a Western Australian tertiary public hospital.
Inpatients (N = 1503) with AAL were identified through medical records and screened for eligibility to participate in a randomized controlled trial. Those recruited were randomized to undergo assessment by skin testing ± oral challenge, or direct oral challenge. A control group received usual care.
Of the 1503 inpatients with an AAL, 429 (28.5%) were eligible for AAL assessment. The primary excluding factor (1074 [71.5%]) was contraindicated medication use (387 [36.0%]), followed by cognitive impairment (298 [27.9%]). Thirty-nine patients were randomized, of which 20 received allergy testing and 19 usual care; all patients were followed up for 5 years. Older patients were less likely to be eligible (10-year increase: odds ratio, 0.82; 95% CI, 0.77-0.88; < .0001), whereas surgical patients were more likely to be eligible than medical patients (odds ratio, 2.49; 95% CI, 1.97-3.16; < .0001).
Antibiotic allergy delabeling in the acute care context is not straightforward. Competing clinical concerns and patient acceptance are some barriers to an inpatient service. Nor is it apparent that inpatient versus outpatient testing is cost saving although select patient groups may benefit. Testing younger people and those with predicted high antibiotic usage will derive maximal individual and health system benefits.
抗生素过敏标签的临床后果是有害的，会影响医疗服务的提供和患者的治疗结果。我们对住院患者进行了评估，旨在一项随机对照试验中提供免费的抗生素过敏标签（AAL）评估。
我们试图确定在西澳大利亚一家三级公立医院建立成人抗生素过敏标签去除服务的可行性。
通过病历识别出有AAL的住院患者（N = 1503），并筛选其参与随机对照试验的资格。招募的患者被随机分配接受皮肤试验±口服激发试验评估，或直接口服激发试验。对照组接受常规护理。
在1503名有AAL的住院患者中，429名（28.5%）有资格进行AAL评估。主要排除因素（1074名[71.5%]）是禁忌药物使用（387名[36.0%]），其次是认知障碍（298名[27.9%]）。39名患者被随机分组，其中20名接受过敏测试，19名接受常规护理；所有患者均随访5年。老年患者符合资格的可能性较小（年龄每增加10岁：比值比，0.82；95%可信区间，0.77 - 0.88；P <.0001），而外科患者比内科患者更有可能符合资格（比值比，2.49；95%可信区间，1.97 - 3.16；P <.0001）。
在急性护理环境中去除抗生素过敏标签并非易事。相互竞争的临床问题和患者接受度是住院服务的一些障碍。虽然特定患者群体可能受益，但住院测试与门诊测试相比是否节省成本也不明显。对年轻人和预计抗生素使用量高的人进行测试将为个人和卫生系统带来最大益处。
