Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study.

Autor:	Wong J; Division of Infectious Diseases, McMaster Children's Hospital, Hamilton, Ontario, Canada wongj37@mcmaster.ca.; Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.; Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada., Atkinson A; Division of Immunology and Allergy, The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Timberlake K; Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada., Beck CE; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada., Maguire B; The Hospital for Sick Children, Toronto, Ontario, Canada., Science M; Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Archives of disease in childhood [Arch Dis Child] 2024 Dec 13; Vol. 110 (1), pp. 26-30. Date of Electronic Publication: 2024 Dec 13.
DOI:	10.1136/archdischild-2023-326533
Abstrakt:	Objective: To evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT). Design: One-year quality improvement study using a before-after design. Setting: Free-standing tertiary care paediatric hospital. Patients: Patients with a reported beta-lactam allergy admitted to the paediatric medicine inpatient unit. Interventions: Following standardised assessment and risk stratification of reported symptoms, patients with a low-risk history were offered an OPT. Beta-lactam allergy labels were removed if a reported history was considered non-allergic or after successful OPT. Main Outcome Measures: Removal of inappropriate beta-lactam allergy labels. Results: 80 patients with 85 reported beta-lactam allergies were assessed. Median age was 8.1 years (IQR 4.8-12.9) and 34 (42%) were female. The majority (n=55, 69%) had an underlying medical condition. Amoxicillin was the most reported allergy (n=25, 29%). Reported reactions were primarily dermatological (n=65, 77%). Half of participants (n=40) were ineligible for OPT, with equal proportions due to clinical reasons or the nature of the reported reaction. Of the 40 eligible patients, 28 patients (70%) were de-labelled either by history alone (n=10) or OPT (n=18). All OPTs were successful. De-labelling allowed five additional patients (11% of those receiving antibiotics) to receive the preferred beta-lactam. Including patients who were subsequently assessed in the allergy clinic, almost half of all evaluated patients were de-labelled (n=37, 46%). Conclusions: An antimicrobial stewardship programme-led programme using a direct OPT was feasible and safe for expanding beta-lactam allergy de-labelling to paediatric patients admitted to the paediatric medicine inpatient unit. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)
Databáze:	MEDLINE
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