The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort study
Objectives: Inpatient penicillin allergy is associated with inappropriate antibiotic prescribing and adverse patient outcomes. We reviewed the long-term effectiveness, safety and antimicrobial stewardship impacts of a pharmacist-led penicillin allergy delabelling ward round. Methods: Adult inpatient...
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Elsevier
2024-12-01
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| Series: | CMI Communications |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950590924050558 |
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| author | Elise Mitri Sara Vogrin Kyra YL Chua Ana-Maria Copaescu Jamie Waldron Fionnuala Cox Misha Devchand Rebecca Hall Kerryn McInnes Natasha E Holmes Courtney Ierano Jason A. Roberts Suran L Fernando Gemma K Reynolds Jason A Trubiano |
| author_facet | Elise Mitri Sara Vogrin Kyra YL Chua Ana-Maria Copaescu Jamie Waldron Fionnuala Cox Misha Devchand Rebecca Hall Kerryn McInnes Natasha E Holmes Courtney Ierano Jason A. Roberts Suran L Fernando Gemma K Reynolds Jason A Trubiano |
| author_sort | Elise Mitri |
| collection | DOAJ |
| description | Objectives: Inpatient penicillin allergy is associated with inappropriate antibiotic prescribing and adverse patient outcomes. We reviewed the long-term effectiveness, safety and antimicrobial stewardship impacts of a pharmacist-led penicillin allergy delabelling ward round. Methods: Adult inpatients with a penicillin allergy label were evaluated during a pharmacist-led penicillin allergy ward round implemented within a tertiary referral health service in Melbourne, Australia for more than three years. Using the validated Antibiotic Allergy Assessment Tool (AAAT) and PEN-FAST clinical decision rule, patients with a low-risk penicillin allergy or PEN-FAST score <3, were offered a single-dose direct oral challenge. Inpatient antimicrobial prescribing was reviewed pre-allergy assessment, post-delabelling, and three months post-discharge. Results: Between 21 January 2019 and 24 August 2022, 477 inpatients were reviewed. Direct oral challenge was effective, with 158/166 (95.2%) low-risk inpatients delabelled. One hundred eleven (23.2%) patients had a non-immune mediated penicillin allergy label and were directly delabelled. No serious adverse events occurred. Penicillin prescribing was increased during the index admission (OR 12.06, 95% CI [5.10–28.47]) and at three months post-intervention (OR 16.45, 95% CI [3.90–69.30]) for delabelled patients, compared with those not delabelled. Conclusions: Inpatient penicillin allergy delabelling was deemed effective, safe and sustainable in a pharmacist-led program, with improved inpatient antimicrobial prescribing during the index admission and following discharge. |
| format | Article |
| id | doaj-art-15e495bdfd8144258d0a46a1cb83a155 |
| institution | DOAJ |
| issn | 2950-5909 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | CMI Communications |
| spelling | doaj-art-15e495bdfd8144258d0a46a1cb83a1552025-08-20T02:41:08ZengElsevierCMI Communications2950-59092024-12-011310505510.1016/j.cmicom.2024.105055The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort studyElise Mitri0Sara Vogrin1Kyra YL Chua2Ana-Maria Copaescu3Jamie Waldron4Fionnuala Cox5Misha Devchand6Rebecca Hall7Kerryn McInnes8Natasha E Holmes9Courtney Ierano10Jason A. Roberts11Suran L Fernando12Gemma K Reynolds13Jason A Trubiano14Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Pharmacy, Austin Health, Victoria, Australia; National Allergy Centre of Excellence (NACE), Parkville, VIC, Australia; Corresponding author at: Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Level 7, Harold Stokes Building, 145 Studley Road, Heidelberg, Australia.Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, AustraliaDepartment of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, AustraliaDepartment of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Medicine, McGill University Health Centre, Montreal, CanadaDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USACentre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, AustraliaCentre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; Department of Pharmacy, Austin Health, Victoria, AustraliaCentre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, AustraliaCentre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, AustraliaDepartment of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, AustraliaDepartment of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia; National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Victoria, AustraliaUniversity of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia; Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; UR UM 103, University of Montpellier, Division of Anesthesia Critical Care and Emergency and Pain Medicine, Nimes University Hospital, Nimes, FranceDepartment of Clinical Immunology and Allergy, Royal North Shore Hospital, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, AustraliaCentre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, AustraliaDepartment of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Victoria, AustraliaObjectives: Inpatient penicillin allergy is associated with inappropriate antibiotic prescribing and adverse patient outcomes. We reviewed the long-term effectiveness, safety and antimicrobial stewardship impacts of a pharmacist-led penicillin allergy delabelling ward round. Methods: Adult inpatients with a penicillin allergy label were evaluated during a pharmacist-led penicillin allergy ward round implemented within a tertiary referral health service in Melbourne, Australia for more than three years. Using the validated Antibiotic Allergy Assessment Tool (AAAT) and PEN-FAST clinical decision rule, patients with a low-risk penicillin allergy or PEN-FAST score <3, were offered a single-dose direct oral challenge. Inpatient antimicrobial prescribing was reviewed pre-allergy assessment, post-delabelling, and three months post-discharge. Results: Between 21 January 2019 and 24 August 2022, 477 inpatients were reviewed. Direct oral challenge was effective, with 158/166 (95.2%) low-risk inpatients delabelled. One hundred eleven (23.2%) patients had a non-immune mediated penicillin allergy label and were directly delabelled. No serious adverse events occurred. Penicillin prescribing was increased during the index admission (OR 12.06, 95% CI [5.10–28.47]) and at three months post-intervention (OR 16.45, 95% CI [3.90–69.30]) for delabelled patients, compared with those not delabelled. Conclusions: Inpatient penicillin allergy delabelling was deemed effective, safe and sustainable in a pharmacist-led program, with improved inpatient antimicrobial prescribing during the index admission and following discharge.http://www.sciencedirect.com/science/article/pii/S2950590924050558Penicillin allergyAntimicrobial stewardshipDelabelingPharmacist |
| spellingShingle | Elise Mitri Sara Vogrin Kyra YL Chua Ana-Maria Copaescu Jamie Waldron Fionnuala Cox Misha Devchand Rebecca Hall Kerryn McInnes Natasha E Holmes Courtney Ierano Jason A. Roberts Suran L Fernando Gemma K Reynolds Jason A Trubiano The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort study CMI Communications Penicillin allergy Antimicrobial stewardship Delabeling Pharmacist |
| title | The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort study |
| title_full | The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort study |
| title_fullStr | The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort study |
| title_full_unstemmed | The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort study |
| title_short | The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort study |
| title_sort | long term sustainability of a pharmacist led antimicrobial stewardship penicillin allergy delabelling ward round a prospective cohort study |
| topic | Penicillin allergy Antimicrobial stewardship Delabeling Pharmacist |
| url | http://www.sciencedirect.com/science/article/pii/S2950590924050558 |
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