Delabeling of allergy to beta-lactam antibiotics in hospitalized patients: a prospective study evaluating cost savings

Background Patients with a penicillin allergy label are at risk of an associated increase in adverse antibiotic events and hospitalization costs. Aim We aimed to study the economic savings derived from the correct diagnosis and delabeling inpatients with suspected beta-lactam allergy, considering the acquisition cost of antimicrobials prescribed during a patient's hospital stay. Method We prospectively evaluated patients admitted to the University Hospital of Salamanca who had been labeled as allergic to beta-lactams and performed a delabeling study. Subsequently, cost differences between antibiotics administered before and after the allergy study and those derived from those patients who received alternative antibiotics during admission and those who switched to beta-lactams after the allergy study were calculated. Results One hundred seventy-seven inpatients labeled as allergic to beta-lactams underwent a delabeling study; 34 (19.2%) were confirmed to have allergy to beta-lactams. Of the total number of patients, 136 (76.8%) received antibiotics during their hospitalization, involving a mean (SD) cost of <euro>203.07 (318.42) and a median (IQR) cost of <euro>88.97 (48.86-233.56). After delabeling in 85 (62.5%) patients, the antibiotic treatment was changed to beta-lactams. In this group of patients, the mean cost (SD) decreased from <euro>188.91 (351.09) before the change to 91.31 (136.07) afterward, and the median cost (IQR) decreased from <euro>72.92 (45.82-211.99) to <euro>19.24 (11.66-168). The reduction was significant compared to the median cost of patients whose treatment was not changed to beta-lactams (p<0.001). Conclusion Delabeling hospitalized patients represents a cost-saving measure for treating patients labeled as allergic to beta-lactams.