Patient-related factors impact the implementation of inpatient antibiotic allergy delabeling.

Autor:	Herrmann S; School of Medicine, The University of Western Australia, Perth, Australia., Kulkarni R; School of Medicine, The University of Western Australia, Perth, Australia.; Department of Immunology, Sir Charles Gairdner Hospital, Perth, Australia., Trevenen M; Centre for Applied Statistics, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Australia., Karuppasamy H; Department of Immunology, Sir Charles Gairdner Hospital, Perth, Australia., Willis C; Department of Immunology, Fiona Stanley Hospital, Perth, Australia., Berry R; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia., Von Ungern-Sternberg B; Department of Immunology, Sir Charles Gairdner Hospital, Perth, Australia.; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia.; Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Australia.; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia., Warrier N; School of Medicine, The University of Western Australia, Perth, Australia., Li I; National Centre for Student Equity in Higher Education, Curtin University, Perth, Australia., Murray K; School of Population Health, The University of Western Australia, Perth, Australia., Lucas M; School of Medicine, The University of Western Australia, Perth, Australia.; Department of Immunology, Sir Charles Gairdner Hospital, Perth, Australia.
Jazyk:	angličtina
Zdroj:	The journal of allergy and clinical immunology. Global [J Allergy Clin Immunol Glob] 2024 Aug 21; Vol. 3 (4), pp. 100326. Date of Electronic Publication: 2024 Aug 21 (Print Publication: 2024).
DOI:	10.1016/j.jacig.2024.100326
Abstrakt:	Background: The clinical consequences of an antibiotic allergy label are detrimental, impacting health care delivery and patient outcomes. We assessed hospital inpatients with intent to offer free antibiotic allergy labeling (AAL) assessment within a randomized controlled trial. Objective: We sought to determine the feasibility of establishing an adult antibiotic allergy delabeling service in a Western Australian tertiary public hospital. Methods: Inpatients (N = 1503) with AAL were identified through medical records and screened for eligibility to participate in a randomized controlled trial. Those recruited were randomized to undergo assessment by skin testing ± oral challenge, or direct oral challenge. A control group received usual care. Results: Of the 1503 inpatients with an AAL, 429 (28.5%) were eligible for AAL assessment. The primary excluding factor (1074 [71.5%]) was contraindicated medication use (387 [36.0%]), followed by cognitive impairment (298 [27.9%]). Thirty-nine patients were randomized, of which 20 received allergy testing and 19 usual care; all patients were followed up for 5 years. Older patients were less likely to be eligible (10-year increase: odds ratio, 0.82; 95% CI, 0.77-0.88; P  < .0001), whereas surgical patients were more likely to be eligible than medical patients (odds ratio, 2.49; 95% CI, 1.97-3.16; P  < .0001). Conclusions: Antibiotic allergy delabeling in the acute care context is not straightforward. Competing clinical concerns and patient acceptance are some barriers to an inpatient service. Nor is it apparent that inpatient versus outpatient testing is cost saving although select patient groups may benefit. Testing younger people and those with predicted high antibiotic usage will derive maximal individual and health system benefits. Competing Interests: The Government of Western Australia, Department of Health, Research Translation Project. BSvUS is partly funded by the 10.13039/501100020265Stan Perron Charitable Foundation and through a 10.13039/501100000925National Health and Medical Research Council Investigator Grant (grant no. 2009322). Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. (© 2024 The Authors.)
Databáze:	MEDLINE
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