A Prospective Observational Study of the Effect of Penicillin Skin Testing on Antibiotic Use in the Intensive Care Unit
| Autor: | Marc J. Popovich, Mercedes E. Arroliga, Alejandro C. Arroliga, Steven M. Gordon, Christine Radojicic, Alton L. Melton, C. Allen Bashour |
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| Rok vydání: | 2003 |
| Předmět: |
Microbiology (medical)
Pediatrics medicine.medical_specialty Lactams Epidemiology medicine.drug_class Antibiotics Penicillins law.invention Drug Hypersensitivity law Humans Medicine Prospective Studies Adverse effect Ohio Skin Tests Antibacterial agent business.industry Antimicrobial Intensive care unit Drug Resistance Multiple Anti-Bacterial Agents Penicillin Intensive Care Units Infectious Diseases Vancomycin Penicillin Antibiotic business medicine.drug |
| Zdroj: | Infection Control & Hospital Epidemiology. 24:347-350 |
| ISSN: | 1559-6834 0899-823X 0195-9417 |
| Popis: | Background:Patients with penicillin allergy admitted to the intensive care unit (ICU) frequently receive non-beta-lactam antimicrobials for the treatment of infection. The use of these antimicrobials, more commonly vancomycin and fluoroquinolones, is associated with the emergence of multidrug-resistant infections. The penicillin skin test (PST) can help detect patients at risk of developing an immediate allergic reaction to penicillin and those patients with a negative PST may be able to use a penicillin antibiotic safely.Methods:We determined the incidence of true penicillin allergy, the percentage of patients changed to a beta-lactam antimicrobial when the test was negative, the safety of the test, and the safety of administration of beta-lactam antimicrobials in patients with a negative test. Skin testing was performed using standard methodology.Results:One hundred patients admitted to 4 ICUs were prospectively studied; 58 of them were male. The mean age was 63 years. Ninety-six patients had the PST: one was positive (1.04%), 10 (10.4%) were nondiagnostic, and 85 (88.5%) were negative. Of the 38 patients who received antimicrobials for therapeutic reasons, 31(81.5%) had the antibiotic changed to a beta-lactam antimicrobial after a negative reading versus 7 patients of the 57 (12%) who had received a prophylactic antimicrobial (P < .001). No adverse effects were reported after the PST or after antimicrobial administration.Conclusions:The PST is a safe, reliable, and effective strategy to reduce the use of non-beta-lactam antimicrobials in patients who are labeled as penicillin allergic and admitted to the ICU. |
| Databáze: | OpenAIRE |
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