Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec;21(6):e13175.
doi: 10.1111/tid.13175. Epub 2019 Oct 1.

Penicillin allergy skin testing as an antibiotic stewardship intervention reduces alternative antibiotic exposures in hematopoietic stem cell transplant recipients

Anita R Modi  1 , Navneet S Majhail  2   3 , Lisa Rybicki  4 , Vasilios Athans  5 , Kelley Carlstrom  6 , Pavithra Srinivas  6 , David M Lang  7 , Ronald Sobecks  2   3 , Christopher S Kovacs  1   3
Affiliations

Penicillin allergy skin testing as an antibiotic stewardship intervention reduces alternative antibiotic exposures in hematopoietic stem cell transplant recipients

Anita R Modi et al. Transpl Infect Dis. 2019 Dec.

Abstract

Background: Antibiotic allergy de-labeling using penicillin allergy skin testing (PAST) can reduce the use and cost of alternative, non-β-lactam antibiotics in general inpatient populations. This strategy's role in hematopoietic stem cell transplant (HSCT) recipients is unclear.

Methods: This study aimed to determine the effect of a pre-transplant PAST protocol on antibiotic use, days of therapy (DOT), and cost in an immunocompromised population at a single center from 7/1/2010-2/1/2019. Patients who received chimeric antigen receptor (CAR) T-cell therapy and those who underwent transplantation in the outpatient setting were excluded.

Results: Of 1560 patients who underwent inpatient HSCT during the study period, 208 reported β-lactam allergy (136/844 [16%] pre- and 72/716 [10%] post-implementation; P < .001). PAST was performed on 7% and 54% of HSCT recipients pre- and post-implementation, respectively. Only two positive PAST were noted. There were no adverse reactions to PAST. There were no significant differences in the disease and transplant characteristics between the two groups. Days of therapy and cost of alternative antibiotics significantly decreased post-implementation (mean 788 vs 627 days, P = .01; mean $24 425 vs $17 518, P = .009).

Conclusion: Penicillin allergy skin testing adjudicates reported β-lactam allergy in HSCT recipients, lowering use, DOT, and cost of alternative antibiotics and promoting effective formulary agents to treat immunocompromised HSCT recipients.

Keywords: allergy; antibiotic; beta-lactam; de-labeling; penicillin; stem cell transplant; stewardship.

PubMed Disclaimer

References

REFERENCES

    1. Wang Y, Zhou J, Wu K. High 28-day mortality in critically ill patients with sepsis and concomitant active cancer. J Int Med Res. 2018;46(12):5030-5039.
    1. Bonine NG, Berger A, Altincatal A, et al. Impact of delayed appropriate antibiotic therapy on patient outcomes by antibiotic resistance status from serious Gram-negative bacterial infections. Am J Med Sci. 2019;357(2):103-110.
    1. Huang K, Cluzet V, Hamilton K, Fadugba O. The impact of reported beta-lactam allergy in hospitalized patients with hematologic malignancies requiring antibiotics. Clin Infect Dis. 2017;67(1):27-33.
    1. Charneski L, Deshpande G, Smith SW. Impact of an antimicrobial allergy label in the medical record on clinical outcomes in hospitalized patients. Pharmacotherapy. 2011;31(8):742-747.
    1. Jeffres MN, Narayanan PP, Shuster JE, et al. Consequences of avoiding beta-lactams in patients with beta-lactam allergies. J Allergy Clin Immunol. 2016;137:1148-1153.

MeSH terms

LinkOut - more resources