Cox F, Vogrin S, Sullivan R P, Stone C, Koo G, Phillips E, Li J, Fernando S L, Al Gassim M, Mitri E, De Luca J, Rose M, Chua K Y L, Holmes N E, Copaescu A M, Trubiano J A
Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Heidelberg, Victoria, Australia.
Department of Infectious Diseases, St George Hospital, School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia.
J Infect. 2025 Jun;90(6):106495. doi: 10.1016/j.jinf.2025.106495. Epub 2025 Apr 25.
Like penicillin allergy labels, cephalosporin allergy labels go largely unverified and drive inappropriate antibiotic use. Clinical decision rules (CDR) have been validated to identify low-risk penicillin allergy labelled patients suitable for direct oral challenge (DOC); however, the generalisability to cephalosporin allergy remains uncertain.
Cephalosporin allergy tested cohorts from three hospitals in Australia were used for validation of a cephalosporin allergy CDR based on clinical variables utilised in the published penicillin allergy decision rule (PEN-FAST). Patients with a cephalosporin allergy label underwent allergy testing. North American tested cohorts were used for external validation.
From an Australian validation cohort of 228 patients and an external cohort of 167 patients, the four clinical features associated with a positive penicillin allergy from PEN-FAST showed similar associations to a positive cephalosporin test, with minor adjustments to scoring. Validation showed an AUROC of 0.921. A cut-off of less than three points for the newly directed CEPH-FAST was chosen to classify a low risk of cephalosporin allergy, for which six of 105 patients (5.7%) had positive allergy testing results.
Utilising the previously published and internationally validated tool PEN-FAST, we validated the same criteria with minor modifications for low-risk cephalosporin allergies. The results suggest that a CEPH-FAST score of less than three is associated with a high negative predictive value and could be used by clinicians and antimicrobial stewardship programmes to identify patients with low-risk cephalosporin allergies at the point of care, following local validation, who could proceed to DOC or use non-cross-reactive cephalosporins.
与青霉素过敏标签一样，头孢菌素过敏标签大多未经核实，并导致不适当的抗生素使用。临床决策规则（CDR）已得到验证，可识别适合直接口服激发试验（DOC）的低风险青霉素过敏标签患者；然而，其对头孢菌素过敏的通用性仍不确定。
来自澳大利亚三家医院的头孢菌素过敏检测队列用于基于已发表的青霉素过敏决策规则（PEN-FAST）中使用的临床变量对头孢菌素过敏CDR进行验证。有头孢菌素过敏标签的患者接受过敏检测。北美检测队列用于外部验证。
在澳大利亚的228名患者验证队列和167名患者的外部队列中，PEN-FAST中与青霉素过敏阳性相关的四个临床特征与头孢菌素检测阳性显示出相似的关联，只是评分略有调整。验证显示曲线下面积（AUROC）为0.921。新制定的CEPH-FAST的截断值选择为低于三分，以分类为头孢菌素过敏低风险，105名患者中有6名（5.7%）过敏检测结果为阳性。
利用先前发表并经过国际验证的工具PEN-FAST，我们对低风险头孢菌素过敏的相同标准进行了微调验证。结果表明，CEPH-FAST评分低于三分与高阴性预测值相关，临床医生和抗菌药物管理计划可在当地验证后，在护理点使用该评分来识别低风险头孢菌素过敏的患者，这些患者可以进行DOC或使用非交叉反应性头孢菌素。
