New Approaches To Improving Antibiotic Stewardship And Combating The Growing Public Health Threat

National survey data supports need for penicillin skin testing in hospitals

Nov 18, 2015, 12:44 ET from PRE-PEN

ROUND ROCK, Texas, Nov. 18, 2015 /PRNewswire/ -- This week the CDC highlights their Get Smart About Antibiotics Week, to increase awareness of proper antibiotic use. During the last few months, medical experts attending two major health conferences discussed how health care organizations can improve proper antibiotic use in order to combat the growing global health threat of antimicrobial resistance. The role penicillin allergies play in the treatment of patients, contribute to antibiotic misuse and the increase in cost of care were some of the major points raised. At IDWeek 2015TM an annual meeting of the Infectious Diseases Society of America (IDSA) and the 2015 American College of Allergy, Asthma, and Immunology Annual Scientific Meeting (ACAAI 2015), new ways to fight "Super Bugs" was a common theme.

National survey data results show a need for penicillin skin testing to improve patient outcomes. "Patients labeled penicillin allergic tend to require longer hospital stays and have higher rates of antibiotic resistant bacteria," said Roland Solensky, MD, The Corvallis Clinic.

In patients with antibiotic allergies, including a penicillin allergy, there is a 38% deviation from the standard guidelines of care that leads to antimicrobial resistance in the patient, longer hospital stays, and increases in both ICU admissions and cost of care. Patients with a penicillin allergy had more antibiotic resistant bacteria  — 30% more VRE, 23% C. difficile and 14% MRSA[1] — the SuperBug trifecta.

It is critical that hospitals and health care providers test individuals with unverified penicillin allergies at hospital admission or prior to elective admissions.  "Only about 5% of patients who report a history of penicillin allergy, when evaluated by a skin test and an oral challenge, are actually allergic to penicillins.  Individuals with unverified penicillin allergies spend about 10% more time in the hospital and get 20% to 30% more serious antibiotic resistant infections, because they are not given optimal antibiotic therapy. Penicillin allergy testing is becoming recognized as an important part of an effective antibiotic stewardship program," says Eric Macy, MD, Kaiser Permanente, San Diego.

Other benefits of skin testing are increased usage of drugs of choice, decreased usage of more expensive antimicrobials and avoidance of broad-spectrum antimicrobials,"  says Ramzy Rimawi, MD, Emory University, Atlanta. Most patients with a suspected penicillin allergy are candidates for skin testing.

One small study showed that 70% of doctors said an inpatient penicillin skin testing service involving the Infectious Disease fellows would benefit patient care and antimicrobial stewardship purposes in their hospitals. "One hospital demonstrated an estimated annual savings of $82,000 from PST-guided antibiotic changes alone, without estimating its' effects on antimicrobial resistance, alternative therapy adverse effects, or future antibiotic prescription." continued Rimawi.

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1 Macy et al. J Allergy Clin Immunol 2014