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- Title
Evaluation of a Pharmacist-Led Penicillin Allergy Assessment Program and Allergy Delabeling in a Tertiary Care Hospital.
- Authors
Turner, Nicholas A.; Wrenn, Rebekah; Sarubbi, Christina; Kleris, Renee; Lugar, Patricia L.; Radojicic, Christine; Moehring, Rebekah W.; Anderson, Deverick J.
- Abstract
Key Points: Question: Are pharmacist-led allergy assessments associated with improved antibiotic selection and reduced Clostridioides difficile infection rates? Findings: In this longitudinal cross-sectional study examining 46 416 admissions, allergy assessments and penicillin skin testing were temporally associated with reduced use of high Clostridioides difficile infection–risk antibiotics, and penicillin skin testing was associated with a reduced incidence of hospital-acquired Clostridioides difficile infection. In an embedded propensity-matched case-control study including 1091 patients, penicillin skin testing was similarly associated with reduced receipt of high Clostridioides difficile infection–risk antibiotics. Meaning: Pharmacist-led allergy assessments may be a useful tool for reducing high-risk antibiotic use and hospital-acquired Clostridioides difficile infection. Importance: Penicillin allergies are frequently mislabeled, which may contribute to use of less-preferred alternative antibiotics. Objective: To evaluate a pharmacist-led allergy assessment program's association with antimicrobial use and clinical outcomes. Design, Setting, and Participants: A pharmacist-led allergy assessment program was launched in 2 phases (June 1, 2015, and November 2, 2016) at a single-center tertiary referral hospital. The longitudinal cross-sectional study included all study period adult admissions; hospitalwide outcomes were assessed by segmented regression. Individual outcomes were assessed within an embedded propensity score–matched case-control study of inpatients undergoing comprehensive allergy assessment following self-report of penicillin allergy. Analysis occurred from March 1, 2020, to February 29, 2020. Exposures: The longitudinal study analyzed hospital-level outcomes over 3 periods: preintervention (15 months), phase 1 (structured allergy history alone, 16 months), and phase 2 (comprehensive assessment including penicillin skin testing, 52 months). The case-control study defined cases as individuals undergoing comprehensive allergy assessment. Main Outcomes and Measures: Hospital-level outcomes included antibiotic days of therapy per 1000 patient-days and hospital-acquired Clostridioides difficile infection (CDI) incidence per 10 000 patient-days. Individual outcomes included antibiotic selection, overall survival, and CDI-free survival. Results: Longitudinal analysis spanned 2014-2020 (median admissions, 46 416 per year; interquartile range [IQR], 46 001-50 091 per year). Hospitalwide, allergy histories were temporally associated with decreased use of nonpenicillin alternative antibiotics (rate ratio, 0.87; 95% CI, 0.79-0.97) and high-CDI-risk antibiotics (rate ratio, 0.91; 95% CI, 0.85-0.98). Penicillin skin testing was temporally associated with lower hospital-acquired CDI rates (rate ratio, 0.61; 95% CI, 0.43-0.86). The embedded case-control study included 272 cases and 819 controls. Median age was 63 years (interquartile range, 51-73 years), 553 (50.7%) patients were women, and 229 (21.0%) patients were Black. Allergy-assessed patients were less likely to receive high-CDI-risk antibiotics at discharge (odds ratio, 0.66; 95% CI, 0.44-0.98). Estimated reductions in mortality (hazard ratio, 0.77; 95% CI, 0.55-1.07) and hospital-acquired CDI risk (hazard ratio, 0.53; 95% CI, 0.18-1.55) were not statistically significant. Conclusions and Relevance: Pharmacist-led allergy assessments may be associated with reduced high-CDI-risk antibiotic use at both hospitalwide and individual levels. Although individual reductions in mortality and CDI risk did not achieve significance, divergence of survival curves suggest longer-term benefits of allergy delabeling warrant future study. This cross-sectional study examines the association of initiation of pharmacist-led assessment of allergy status in patients with self-reported penicillin allergy with antimicrobial use and clinical outcomes in a tertiary care hospital in the US.
- Subjects
MORTALITY prevention; CROSS infection prevention; HOSPITALS; SURVIVAL; EVALUATION of human services programs; CONFIDENCE intervals; SCIENTIFIC observation; CROSS-sectional method; SELF-evaluation; BLACK people; TERTIARY care; ANTI-infective agents; PATIENTS; REGRESSION analysis; CASE-control method; CROSS infection; DISEASE incidence; PENICILLIN; TREATMENT effectiveness; HOSPITAL admission &; discharge; CLOSTRIDIUM diseases; RISK assessment; DESCRIPTIVE statistics; TIME series analysis; DRUG allergy; DECISION making in clinical medicine; ODDS ratio; LOGISTIC regression analysis; STATISTICAL models; LONGITUDINAL method; PROBABILITY theory; DISCHARGE planning; PROPORTIONAL hazards models; DISEASE risk factors; EVALUATION
- Publication
JAMA Network Open, 2021, Vol 4, Issue 5, pe219820
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.9820