Improving Antibiotic Stewardship for Inpatients with Reported Beta-Lactam Allergies and Limited Access to Penicillin...

Area of Science:

• Infectious Diseases
• Clinical Quality Improvement
• Allergy and Immunology

Background:

• Reported penicillin allergy is common, but true allergy is rare, leading to overuse of alternative antibiotics.
• Inpatients with reported beta-lactam allergy often receive non-beta-lactam antibiotics due to limited penicillin skin testing (PST) access.
• Effective management strategies for beta-lactam allergies are crucial for optimizing antibiotic use in hospitalized patients.

Purpose of the Study:

• To increase the safe utilization of beta-lactam antibiotics in inpatients with reported beta-lactam allergy.
• To improve the management of beta-lactam allergies in hospitals with limited access to penicillin skin testing (PST).
• To enhance access to graded challenges for patients with reported beta-lactam allergies.

Main Methods:

• A four-phase quality improvement project was implemented, including guideline updates, multidisciplinary education, and antimicrobial stewardship software utilization.
• Updated hospital guidelines permitted cephalosporin graded challenges without prior penicillin skin testing (PST).
• Physicians, physician assistants, and nurses received education on beta-lactam allergy classification and management, reinforced by pocket cards.

Main Results:

• A 29.2% increase in beta-lactam antibiotic use (excluding carbapenems) was observed among patients with reported beta-lactam allergy (from 42.2% to 54.5%).
• The project led to a decrease in alternative antibiotic use and no increase in hospital-onset Clostridioides difficile cases.
• Graded challenges increased without any reported anaphylaxis events, and there was no rise in infectious disease or allergy consults.

Conclusions:

• A multiphase quality improvement project successfully increased beta-lactam antibiotic utilization in patients with reported beta-lactam allergies.
• The initiative enhanced access to graded challenges, demonstrating safety and efficacy even with limited penicillin skin testing (PST) availability.
• Improved beta-lactam allergy management can optimize antibiotic selection and reduce reliance on alternative agents without compromising patient safety.