Antimicrobial stewardship intervention: optimizing antibiotic treatment in hospitalized patients with reported antibiotic allergy.

Abstract

BACKGROUND\nReported antibiotic allergy in hospitalized patients seems to be related to more adverse events, the use of reserve antibiotics and longer hospitalizations. Most patients reporting an antibiotic allergy can be de-labelled and therefore an antimicrobial stewardship intervention was set up.\n\n\nAIM\nTo determine the impact of reported antibiotic allergy on the antibiotic treatment of hospitalized patients and prevent unnecessary deviation from the preferred antibiotic treatment by a proactive antimicrobial stewardship intervention.\n\n\nMETHODS\nAn intervention study in a teaching hospital in the Netherlands. Hospitalized patients reporting an antibiotic allergy were included in a three-month period between March and May 2019. Physicians received a training and were provided with a recommendation in the electronic medical record (EMR) in case the preferred antibiotic treatment was unnecessarily avoided due to the allergy label and the patient was eligible for a drug challenge.\n\n\nFINDINGS\nA total of 492 patients were identified accounting for 558 hospital admissions. In 93 cases the antibiotic allergy label interfered with the preferred antibiotic treatment of which 68 were eligible for a drug challenge. A total of 42 patients were challenged. In 40 (95%) patients no allergic reaction was observed, and the preferred antibiotic treatment was given. Two (5%) patients developed a non-severe skin reaction after drug challenge and continued an alternative antibiotic regimen.\n\n\nCONCLUSION\nThis antimicrobial stewardship intervention can be used to provide patients with reported antibiotic allergy labels with the preferred antibiotic treatment and to de-label them after uneventful re-exposure to the antibiotic agent.