A clinical decision support tool advocating penicillin allergy testing in patients taking aztreonam has the potential to improve antimicrobial stewardship and reduce costs, according to researchers.
“Penicillin allergy skin testing (PAST) is gaining recognition as a key component of antimicrobial stewardship,” they wrote in Open Forum Infectious Diseases. “The prevalence of reported penicillin allergy in hospitalized patients is approximately 10% to 20%; however, less than one in 10 individuals carrying this diagnosis is truly allergic.”
In a quasi-experimental study, Justin R. Chen, MD, an allergy and immunology specialist affiliated with the University of Texas Southwestern Medical Center, and colleagues said they integrated a clinical decision support (CDS) tool into the electronic medical records at Parkland Health and Hospital System in Dallas County, Texas, to direct physicians to order penicillin allergy testing for patients receiving aztreonam — a costly alternative for those with reported penicillin allergy that can lose its efficacy more quickly due to antimicrobial resistance. An allergy-trained pharmacist reviewed the orders placed through this new guideline and performed PAST and oral challenges to confirm whether these patients could safely take penicillin.
The researchers compared data on the tests performed, antibiotic use and cost-savings between patients who received active screening (n = 250) and those who were tested under the new guideline (n = 91).
A significantly higher proportion of penicillin-allergic aztreonam patients who received CDS guidance underwent PAST consultations vs. patients who received only active screening (85% vs. 24%; P < .001). The intervention also decreased the median delay between hospital admission and completion of testing from 3.31 to 1.05 days (P = .08). Additionally, the researchers saw a 58% increase in penicillin exposure among those tested under the new guideline (P = .046).
Overall, the use of aztreonam at the hospital decreased from 2.54 to 1.47 administrations per 1,000 patient-days (P = .016), and the antibiotic costs per patient decreased from $1,265.81 to $592.08, representing a 53% savings.
“This study combines EMR-based clinical guidelines and active removal of penicillin allergy to provide therapeutic and financial benefits to both hospitals and patients,” the researchers wrote. “By directing resources to patients at greater risk of accumulating disproportionate antibiotic costs, facilities with limited allergy testing capacity can benefit economically from penicillin allergy de-labeling.” – by Jennifer Byrne
Disclosures: Chen reports receiving travel support from the American Academy of Allergy, Asthma, and Immunology and being a member of the speakers’ bureau for ALK-Abelló.