Antimicrobial stewardship's new weapon? A review of antibiotic allergy and pathways to 'de-labeling'.
Antimicrobial stewardship's new weapon? A review of antibiotic allergy and pathways to 'de-labeling'.
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DOI：
10.1097/qco.0000000000000006
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发表时间：
2013-12
影响因子：
3.9
通讯作者：
Phillips E
中科院分区：
文献类型：
--
作者：
Trubiano J;Phillips E
多重耐药病原体的不断出现和抗菌药物的广泛使用，导致更加重视抗菌药物管理计划。同时，人们对抗生素过敏标签数量的增加及其对抗菌药物使用的影响的认识也有所提高。抗生素过敏去标签和抗菌药物管理计划的整合可能是一个值得进一步关注和研究的途径。最近的文献评价了抗生素过敏管理的有效性（历史去标签、体外试验、皮肤点刺试验、皮内试验和口服激发）以及抗生素过敏标签对患者结局的影响。在β-内酰胺过敏背景下，真实和感知的抗生素过敏交叉反应性的重要性已经得到强调。专门的抗生素过敏去标签诊所，住院抗生素过敏试验和综合抗菌药物管理计划的影响最近已经得到评估。最近的文献支持适当的抗生素过敏体外和体内试验以及随后的抗生素过敏去标签，特别是关于β-内酰胺类抗生素，可以减少广谱抗生素的使用、成本、患者住院时间和死亡率。将抗生素过敏管理整合到住院和门诊抗菌药物管理计划的决策支持系统中，是进一步改善抗生素使用结果的重要机会。
The continued emergence of multiresistant pathogens and widespread antimicrobial use has led to a greater emphasis on antimicrobial stewardship programs. Concurrently, an increased awareness of the rising number of antibiotic allergy labels and impact on antimicrobial use has surfaced. The integration of antibiotic allergy de-labeling and antimicrobial stewardship programs may be a pathway worthy of further focus and investigation. Recent literature has evaluated the efficacy of antibiotic allergy management (historical de-labeling, in-vitro testing, skin prick testing, intradermal testing, and oral challenges) and impact of antibiotic allergy labels on patient outcome. The importance of true and perceived antibiotic allergy cross-reactivity in the setting of β-lactam allergies has been highlighted. The impact of dedicated antibiotic allergy de-labeling clinics, inpatient antibiotic allergy testing, and integrated antimicrobial stewardship programs has been recently appraised. More recent literature supports that appropriate antibiotic allergy in-vitro and in-vivo testing and subsequent antibiotic allergy de-labeling, particularly in regard to β-lactams, can decrease broad-spectrum antibiotic use, costs, patient length of stay, and mortality. Integration of antibiotic allergy management into the decision support systems of inpatient and outpatient antimicrobial stewardship programs represents an important opportunity to further improve measured outcomes from antibiotic utilization.