Antimicrobial stewardship intervention: optimizing antibiotic treatment in hospitalized patients with reported antibiotic allergy

Background: Reported antibiotic allergy in hospitalized patients seems to be related to more adverse events, the use of reserve antibiotics and longer hospitalization. Most patients reporting an antibiotic allergy can be de-labelled; as such, an antimicrobial stewardship intervention was set up. Aim: To determine the impact of reported antibiotic allergy on the antibiotic treatment of hospitalized patients, and prevent unnecessary deviation from the preferred antibiotic treatment by a proactive antimicrobial stewardship intervention. Methods: Hospitalized patients reporting an antibiotic allergy were included in an intervention study at a teaching hospital in the Netherlands between March and May 2019. Physicians received training and were provided with a recommendation in the electronic medical record in case the preferred antibiotic treatment was unnecessarily avoided due to the allergy label and the patient was eligible for a drug challenge. Findings: In total, 492 patients reporting an antibiotic allergy were identified, accounting for 558 hospital admissions. In 93 cases, the antibiotic allergy label interfered with the preferred antibiotic treatment. Sixty-eight of these patients were eligible for a drug challenge, and 42 patients were challenged. In 40 (95%) of these patients, no allergic reaction was observed, and the preferred antibiotic treatment was given. Two (5%) patients developed a non-severe skin reaction after a drug challenge and continued an alternative antibiotic regimen. Conclusion: This antimicrobial stewardship intervention can be used to provide patients with reported antibiotic allergy labels with the preferred antibiotic treatment, and to de-label them after uneventful re-exposure to the antibiotic agent. (C) 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.