Inpatient Penicillin Allergy Evaluation Program Enriches Anti-Microbial Stewardship Aims
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Renee Kleris, MD, Christina Sarubbi, PharmD, Rebekah Wrenn, PharmD, Deverick Anderson, MD MPH, Patricia L. Lugar, MD MS
RATIONALE: The stewardship allergy assessment team (StAAT) consists of representation from pharmacy, infectious disease, and allergy who offer penicillin skin testing (PST) and evaluation for inpatients with penicillin allergy. The program aims to identify patients who no longer have penicillin allergy and allows for optimal antibiotic selection. This team strives to improve patient care by expanding accessibility to this evaluation.

METHODS: Healthcare providers place consults to StAAT for inpatients with penicillin allergy. For eligible patients, the evaluation consists of PST (prick and intradermal) with Pre-Pen® and Penicillin G and if negative a supervised oral challenge to amoxicillin. Data related to allergy history, indication for consult, test results, changes in antibiotic selection, length of stay, cost and satisfaction with the evaluation are recorded.

RESULTS: The StAAT completed a total of 47 penicillin drug allergy evaluations. Infections treated at the time of testing included: pneumonia, fever of unknown origin, neurosyphilis, bacteremia, intravascular, bone/joint, urinary tract, intraabdominal, and skin/soft tissue infections. 44 (94%) were cleared of previous penicillin allergy after negative skin testing and supervised oral challenge to amoxicillin. Two patients had positive PST and 1 had an equivocal PST. A total of 22 (50%) patients were started on a penicillin/penicillin derivative after clearance of allergy. Of the 44 patients who were cleared, all (100%) electronic medical records were appropriately updated.

CONCLUSIONS: A multidisciplinary approach allows for increased accessibility to penicillin allergy evaluations for inpatients. This collaboration leads to improved patient care and greater patient and healthcare provider satisfaction by allowing for use of optimal antimicrobials.