Cargando…
Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs
Penicillin allergy, the most frequently reported drug allergy, has been associated with suboptimal antibiotic therapy, increased antimicrobial resistance, increased rates of Clostridioides difficile colonization and infection, as well as extended hospital length of stay and increased cost. Although...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675589/ https://www.ncbi.nlm.nih.gov/pubmed/36415507 http://dx.doi.org/10.1093/jacamr/dlac116 |
_version_ | 1784833408765001728 |
---|---|
author | Mabilat, Claude Gros, Marie-Françoise Van Belkum, Alex Trubiano, Jason A Blumenthal, Kimberly G Romano, Antonino Timbrook, Tristan T |
author_facet | Mabilat, Claude Gros, Marie-Françoise Van Belkum, Alex Trubiano, Jason A Blumenthal, Kimberly G Romano, Antonino Timbrook, Tristan T |
author_sort | Mabilat, Claude |
collection | PubMed |
description | Penicillin allergy, the most frequently reported drug allergy, has been associated with suboptimal antibiotic therapy, increased antimicrobial resistance, increased rates of Clostridioides difficile colonization and infection, as well as extended hospital length of stay and increased cost. Although up to 10% of all patients may report penicillin allergy, most penicillin allergies are not confirmed. As such, most patients with a penicillin allergy can still safely use penicillin and related drugs following a more precise assessment. Herein, we review the current practices and unmet needs in penicillin allergy testing. The diagnostic algorithm is mostly based on a clinical history assessment followed by in vivo testing, i.e. skin test and/or drug challenge. As these tests are labour and resource intensive, there is increased interest in point-of-care penicillin allergy de-labelling solutions incorporated into Antimicrobial Stewardship Programmes including digital assessment tools. These can be locally parameterized on the basis of characteristics of target populations, incidence of specific allergies and local antibiotic usage to perform clinical risk stratification. Safely ruling out any residual risk remains essential and in vivo drug challenge and/or skin testing should be systematically encouraged. Gradual understanding and convergence of the risk stratification of the clinical presentation of penicillin allergy is enabling a wider implementation of this essential aspect of antimicrobial stewardship through digitalized decision tools and in vivo testing. More research is needed to deliver point of care in vitro diagnostic tools to democratize this de-labelling practice, which would be highly beneficial to patient care. This progress, together with better education of patients and clinicians about the availability, efficacy and safety of penicillin allergy testing, will increase the dissemination of penicillin allergy assessment as an important component of Antimicrobial Stewardship Programmes. |
format | Online Article Text |
id | pubmed-9675589 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-96755892022-11-21 Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs Mabilat, Claude Gros, Marie-Françoise Van Belkum, Alex Trubiano, Jason A Blumenthal, Kimberly G Romano, Antonino Timbrook, Tristan T JAC Antimicrob Resist Review Penicillin allergy, the most frequently reported drug allergy, has been associated with suboptimal antibiotic therapy, increased antimicrobial resistance, increased rates of Clostridioides difficile colonization and infection, as well as extended hospital length of stay and increased cost. Although up to 10% of all patients may report penicillin allergy, most penicillin allergies are not confirmed. As such, most patients with a penicillin allergy can still safely use penicillin and related drugs following a more precise assessment. Herein, we review the current practices and unmet needs in penicillin allergy testing. The diagnostic algorithm is mostly based on a clinical history assessment followed by in vivo testing, i.e. skin test and/or drug challenge. As these tests are labour and resource intensive, there is increased interest in point-of-care penicillin allergy de-labelling solutions incorporated into Antimicrobial Stewardship Programmes including digital assessment tools. These can be locally parameterized on the basis of characteristics of target populations, incidence of specific allergies and local antibiotic usage to perform clinical risk stratification. Safely ruling out any residual risk remains essential and in vivo drug challenge and/or skin testing should be systematically encouraged. Gradual understanding and convergence of the risk stratification of the clinical presentation of penicillin allergy is enabling a wider implementation of this essential aspect of antimicrobial stewardship through digitalized decision tools and in vivo testing. More research is needed to deliver point of care in vitro diagnostic tools to democratize this de-labelling practice, which would be highly beneficial to patient care. This progress, together with better education of patients and clinicians about the availability, efficacy and safety of penicillin allergy testing, will increase the dissemination of penicillin allergy assessment as an important component of Antimicrobial Stewardship Programmes. Oxford University Press 2022-11-19 /pmc/articles/PMC9675589/ /pubmed/36415507 http://dx.doi.org/10.1093/jacamr/dlac116 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Mabilat, Claude Gros, Marie-Françoise Van Belkum, Alex Trubiano, Jason A Blumenthal, Kimberly G Romano, Antonino Timbrook, Tristan T Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs |
title | Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs |
title_full | Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs |
title_fullStr | Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs |
title_full_unstemmed | Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs |
title_short | Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs |
title_sort | improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675589/ https://www.ncbi.nlm.nih.gov/pubmed/36415507 http://dx.doi.org/10.1093/jacamr/dlac116 |
work_keys_str_mv | AT mabilatclaude improvingantimicrobialstewardshipwithpenicillinallergytestingareviewofcurrentpracticesandunmetneeds AT grosmariefrancoise improvingantimicrobialstewardshipwithpenicillinallergytestingareviewofcurrentpracticesandunmetneeds AT vanbelkumalex improvingantimicrobialstewardshipwithpenicillinallergytestingareviewofcurrentpracticesandunmetneeds AT trubianojasona improvingantimicrobialstewardshipwithpenicillinallergytestingareviewofcurrentpracticesandunmetneeds AT blumenthalkimberlyg improvingantimicrobialstewardshipwithpenicillinallergytestingareviewofcurrentpracticesandunmetneeds AT romanoantonino improvingantimicrobialstewardshipwithpenicillinallergytestingareviewofcurrentpracticesandunmetneeds AT timbrooktristant improvingantimicrobialstewardshipwithpenicillinallergytestingareviewofcurrentpracticesandunmetneeds |