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Burden of antibiotic allergy labels in Australian aged care residents: Findings from a national point-prevalence survey

Published online by Cambridge University Press:  19 March 2020

Laura Travis
Affiliation:
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
Leon J. Worth
Affiliation:
Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Melbourne, Australia Department of Medicine, University of Melbourne, Melbourne, Australia
Jason Trubiano
Affiliation:
Department of Infectious Diseases, Austin Health, Heidelberg, Australia
Karin Thursky
Affiliation:
National Centre for Antimicrobial Stewardship, Melbourne, Australia
Noleen Bennett
Affiliation:
Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Melbourne, Australia Department of Infectious Diseases, Austin Health, Heidelberg, Australia National Centre for Antimicrobial Stewardship, Melbourne, Australia Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
Corresponding
E-mail address:

Abstract

Objective:

To determine the prevalence of antibiotic allergy labels (AALs) in Australian aged care residents and to describe the impact of labels on antibiotic prescribing practices.

Design:

Point-prevalence survey.

Setting:

Australian residential aged care facilities.

Participants:

We surveyed 1,489 residents in 407 aged care facilities.

Methods:

Standardized data were collected on a single day between June 1 and August 31, 2018, for residents prescribed an antibiotic. An AAL was reported if it was documented in the resident’s health record. Resident-level data were used to calculate overall prevalence, and antibiotic-level data were used to report relative frequency of AALs for individual antibiotics and classes.

Results:

Among 1,489 residents, 356 (24%) had 1 or more documented AALs. The AALs for penicillin (28.3%), amoxicillin or amoxicillin/clavulanic acid (10.5%), cefalexin (7.2%), and trimethoprim (7.0%) were most commonly reported. The presence of an AAL was associated with significantly less prescribing of penicillins (OR, 0.43; 95% CI, 0.31–0.62; P < .001) and significantly more prescribing of lincosamides (OR, 4.81; P < .001), macrolides (OR, 2.03; P = .007), and tetracyclines (OR, 1.54; P = .033). Of residents with AALs, 7 residents (1.9%) were prescribed an antibiotic that was listed on the allergy section of their health record.

Conclusions:

A high prevalence of AALs was observed among residents of Australian aged care facilities, comparable to the prevalence of AALs in high-risk hospitalized patients. Significant increases in prescribing of lincosamide, macrolide, and tetracycline agents poses a potential risk to aged populations, and future studies must evaluate the benefits of AAL delabelling programs tailored for aged care settings.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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