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A Prospective Observational Study of the Effect of Penicillin Skin Testing on Antibiotic Use in the Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Mercedes E. Arroliga ,
Christine Radojicic ,
Steven M. Gordon ,
Marc J. Popovich ,
C. Allen Bashour ,
Alton L. Melton  and
Alejandro C. Arroliga
Mercedes E. Arroliga
Affiliation:
Allergy Section, The Cleveland Clinic Foundation, Cleveland, Ohio
Christine Radojicic
Affiliation:
Allergy Section, The Cleveland Clinic Foundation, Cleveland, Ohio
Steven M. Gordon*
Affiliation:
Infectious Disease Department, The Cleveland Clinic Foundation, Cleveland, Ohio
Marc J. Popovich
Affiliation:
Anesthesia Department, The Cleveland Clinic Foundation, Cleveland, Ohio
C. Allen Bashour
Affiliation:
Anesthesia Department, The Cleveland Clinic Foundation, Cleveland, Ohio
Alton L. Melton
Affiliation:
Allergy Section, The Cleveland Clinic Foundation, Cleveland, Ohio
Alejandro C. Arroliga
Affiliation:
Pulmonary and Critical Care Department, The Cleveland Clinic Foundation, Cleveland, Ohio
*
The Cleveland Clinic Foundation, Mailstop S32, Cleveland, OH 44195
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Abstract

Background:

Patients with penicillin allergy admitted to the intensive care unit (ICU) frequently receive non-beta-lactam antimicrobials for the treatment of infection. The use of these antimicrobials, more commonly vancomycin and fluoroquinolones, is associated with the emergence of multidrug-resistant infections. The penicillin skin test (PST) can help detect patients at risk of developing an immediate allergic reaction to penicillin and those patients with a negative PST may be able to use a penicillin antibiotic safely.

Methods:

We determined the incidence of true penicillin allergy, the percentage of patients changed to a beta-lactam antimicrobial when the test was negative, the safety of the test, and the safety of administration of beta-lactam antimicrobials in patients with a negative test. Skin testing was performed using standard methodology.

Results:

One hundred patients admitted to 4 ICUs were prospectively studied; 58 of them were male. The mean age was 63 years. Ninety-six patients had the PST: one was positive (1.04%), 10 (10.4%) were nondiagnostic, and 85 (88.5%) were negative. Of the 38 patients who received antimicrobials for therapeutic reasons, 31(81.5%) had the antibiotic changed to a beta-lactam antimicrobial after a negative reading versus 7 patients of the 57 (12%) who had received a prophylactic antimicrobial (P < .001). No adverse effects were reported after the PST or after antimicrobial administration.

Conclusions:

The PST is a safe, reliable, and effective strategy to reduce the use of non-beta-lactam antimicrobials in patients who are labeled as penicillin allergic and admitted to the ICU.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 5 , May 2003 , pp. 347 - 350
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Salkind, AR, Cuddy, PG, Foxworth, JW. Is this patient allergic to penicillin? An evidence-base analysis of the likelihood of penicillin allergy. JAMA 2001;285:2498–2505.CrossRefGoogle Scholar
2.Lee, CE, Zembower, TR, Fotis, MAet al.The incidence of antimicrobial allergies in hospitalized patients: implication regarding prescribing patterns and emerging bacterial resistance. Arch Intern Med 2000;160:2819–2822.Google Scholar
3.Arroliga, ME, Wagner, W, Bobek, MB, Hoffman-Hogg, L, Gordon, SM, Arroliga, AC. A pilot study of penicillin skin testing in patients with a history of penicillin allergy admitted to a medical ICU. Chest 2000;118:1106–1108.Google Scholar
4.Solensky, R, Earl, HS, Gruchalla, RS. Clinical approach to penicillin-allergic patients: a survey. Ann Allergy Asthma Immunol 2000;84:329–333.CrossRefGoogle ScholarPubMed
5.Yates, RR. New intervention strategies for reducing antibiotics resistance. Chest 1999;115(suppl):24S–27S.CrossRefGoogle Scholar
6.Fridkin, SK, Edwards, JR, Courval, JM, et al.The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 US adult intensive care units. Ann Intern Med 2001;135:175–183.Google Scholar
7.Murthy, R. Implementation of strategies to control antimicrobial resistance. Chest 2001;119(suppl):405S–411S.Google Scholar
8.Niederman, MS. Impact of antibiotics resistance on clinical outcomes and the cost of care. Crit Care Med 2001;29:N114–N120.CrossRefGoogle ScholarPubMed
9.Bernstein, IL, Gruchalla, RS, Lee, RE, et al.Disease management of drug hypersensitivity: a practice parameter. Ann Allergy Asthma Immunol 1999;83:665–695.Google Scholar
10.Erffmeyer, JE, Blaiss, MS. Proving penicillin allergy. Postgrad Med J 1990;2:33–41.CrossRefGoogle Scholar
11.Forrest, DM, Schellenber, RR, Thien, W, King, S, Anis, AH, Dodek, PM. Introduction of a practice guideline for penicillin skin testing improves the appropriateness of antibiotic therapy. Clin Infect Dis 2001;32:1685–1690.CrossRefGoogle ScholarPubMed
12.Lin, RY. A perspective on penicillin allergy. Arch Intern Med 1992;152:930–937.Google Scholar
13.Harris, AD, Sauberman, L, Kabbash, L, Greineder, DK, Samore, MH. Penicillin skin testing: a way to optimize antibiotic utilization. Am J Med 1999;107:166–168.Google Scholar
14.Li, JTC, Markus, PJ, Osmon, DR, Estes, L, Gosselin, VA, Hanssen, AD. Reduction of vancomycin use in orthopedic patients with a history of antibiotic allergy. Mayo Clin Proc 2000;75:902–906.Google Scholar
15.Solensky, R, Earl, HS, Gruchalla, RS. Penicillin allergy: prevalence of vague history in skin test-positive patients. Ann Allergy Asthma Immunol 2000;85:195–199.CrossRefGoogle ScholarPubMed
16.Valyasevi, MA, Van Dellen, RG. Frequency of systematic reaction to penicillin skin tests. Ann Allergy Asthma Immunol 2000;85:363–365.Google Scholar
17.Husni, RN, Goldstein, LS, Arroliga, AC, et al.Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients. Chest 1999;115:1378–1382.Google Scholar
18.Villers, D, Espaze, E, Coste-Burel, M, et al.Nosocomial Acinetobacter baumannii infection: microbiological and clinical epidemiology. Ann Intern Med 1998;129:182–189.Google Scholar