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Penicillin allergy skin testing as an antibiotic stewardship intervention reduces alternative antibiotic exposures in hematopoietic stem cell transplant recipients
Author(s) -
Modi Anita R.,
Majhail Navneet S.,
Rybicki Lisa,
Athans Vasilios,
Carlstrom Kelley,
Srinivas Pavithra,
Lang David M.,
Sobecks Ronald,
Kovacs Christopher S.
Publication year - 2019
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13175
Subject(s) - medicine , antibiotics , penicillin , hematopoietic stem cell transplantation , adverse effect , population , vancomycin , allergy , transplantation , intensive care medicine , immunology , staphylococcus aureus , environmental health , microbiology and biotechnology , biology , genetics , bacteria
Background Antibiotic allergy de‐labeling using penicillin allergy skin testing (PAST) can reduce the use and cost of alternative, non‐β‐lactam antibiotics in general inpatient populations. This strategy's role in hematopoietic stem cell transplant (HSCT) recipients is unclear. Methods This study aimed to determine the effect of a pre‐transplant PAST protocol on antibiotic use, days of therapy (DOT), and cost in an immunocompromised population at a single center from 7/1/2010‐2/1/2019. Patients who received chimeric antigen receptor (CAR) T‐cell therapy and those who underwent transplantation in the outpatient setting were excluded. Results Of 1560 patients who underwent inpatient HSCT during the study period, 208 reported β‐lactam allergy (136/844 [16%] pre‐ and 72/716 [10%] post‐implementation; P < .001). PAST was performed on 7% and 54% of HSCT recipients pre‐ and post‐implementation, respectively. Only two positive PAST were noted. There were no adverse reactions to PAST. There were no significant differences in the disease and transplant characteristics between the two groups. Days of therapy and cost of alternative antibiotics significantly decreased post‐implementation (mean 788 vs 627 days, P = .01; mean $24 425 vs $17 518, P = .009). Conclusion Penicillin allergy skin testing adjudicates reported β‐lactam allergy in HSCT recipients, lowering use, DOT, and cost of alternative antibiotics and promoting effective formulary agents to treat immunocompromised HSCT recipients.