Penicillin skin testing in hospitalized patients with β-lactam allergies Effect on antibiotic selection and cost
Penicillin skin testing in hospitalized patients with β-lactam allergies Effect on antibiotic selection and cost
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DOI：
10.1016/j.anai.2016.04.021
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发表时间：
2016-07-01
影响因子：
5.9
通讯作者：
Bielory, Leonard
中科院分区：
文献类型：
--
作者：
King, Esther A.;Challa, Sridevi;Bielory, Leonard
背景资料：青霉素过敏史一般会导致使用广谱抗生素，可能会增加并发症和cost.Objective：为了确定成本效益进行青霉素皮肤试验（PST）。方法：回顾性分析的成人住院患者与β-内酰胺过敏谁接受PST和口服挑战进行过敏专科医生。主要结果是转换为β-内酰胺抗生素（BLA）的患者的总体抗生素成本节省。次要结果包括随后的入院，需要抗生素和总天数BLA prescribed.Results：50例患者进行PST（平均年龄，62岁）。报告的最常见β-内酰胺过敏是青霉素（92%）。54%的患者报告了皮肤反应，56%的患者在20年前有过皮肤反应。50%的患者在PST前接受了氨曲南处方。所有患者的PST结果均为阴性，1例患者在口服阿莫西林激发期间出现过敏症状（98%皮试或口服激发阴性）。37例患者（75.5%）改为BLA。总成本节省为11，005美元（每名患者转换为BLA为297美元）。有31名随后入院的患者在皮肤试验和口服激发试验中呈阴性，需要抗生素治疗。一个BLA规定在22 31再入院，共147天的BLA therapeutic.Conclusion：PST协议的实施后，我们观察到减少非BLA使用的患者与以前记录的β-内酰胺过敏。PST是一种安全且经济有效的方法，可作为IgE介导的青霉素超敏反应的阴性预测试验。(C)2016年美国过敏，哮喘和免疫学学院。爱思唯尔公司出版All rights reserved.
Background: A history of a penicillin allergy generally leads to the use of broad-spectrum antibiotics that may increase complications and cost.Objective: To determine the cost-effectiveness of performing penicillin skin testing (PST).Methods: A retrospective analysis was conducted on adult inpatients with a beta-lactam allergy who underwent PST and oral challenge performed by an allergist. The primary outcome was overall antibiotic cost savings for patients switched to a beta-lactam antibiotic (BLA). Secondary outcomes included subsequent admissions that required antibiotics and total number of days a BLA was prescribed.Results: Fifty patients had PST performed (mean age, 62 years). The most common beta-lactam allergy reported was penicillin (92%). Cutaneous reactions were reported in 54% of patients, and 56% had a reaction more than 20 years ago. Fifty percent of patients had aztreonam prescribed before PST. The results of PST were negative in all patients, and 1 patient had anaphylactic symptoms during the oral amoxicillin challenge (98% skin test or oral challenge negative). Thirty-seven patients (75.5%) were changed to a BLA. Overall cost savings were $11,005 ($297 per patient switched to a BLA). There were 31 subsequent admissions that required antibiotics for patients who tested negative on skin test and oral challenge. A BLA was prescribed in 22 of 31 readmissions, totaling 147 days of BLA therapy.Conclusion: After the implementation of a PST protocol, we observed a decrease in non-BLA use in patients with previously documented beta-lactam allergy. PST is a safe and cost-effective procedure to serve as a negative predictor test for penicillin hypersensitivity mediated by IgE. (C) 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.