Antibiotic allergy de-labeling in the intensive care unit: The prospective ADE-ICU study

Area of Science:

• Critical Care Medicine
• Pharmacology
• Infectious Diseases

Background:

• Antibiotic allergy labels are prevalent in intensive care units (ICUs), often inaccurately.
• Mislabeling leads to broad-spectrum antibiotic overuse, contributing to antimicrobial resistance and Clostridium difficile infections.
• This can also prolong hospital stays and increase healthcare costs.

Purpose of the Study:

• To implement and evaluate an ICU-led antibiotic allergy assessment and testing program.
• To determine the feasibility of de-labeling antibiotic allergies in critically ill patients.
• To improve antibiotic prescribing patterns and reduce the use of broad-spectrum agents.

Main Methods:

• A prospective study involving trained ICU staff to assess and risk-stratify patients with antibiotic allergies.
• Patients were categorized into non-immune mediated, low, intermediate, or high-risk allergy groups.
• De-labeling strategies included direct de-labeling, drug provocation testing, and skin testing, tailored to risk stratification.

Main Results:

• Out of 71 eligible patients, 62 were assessed, with 48 of 51 (94%) low or intermediate-risk allergies successfully de-labeled.
• High-risk allergies were confirmed in 11 patients (18%).
• The program led to increased penicillin use and decreased broad-spectrum antibiotic use, with no adverse events.

Conclusions:

• ICU-led antibiotic allergy assessment and testing is feasible and effective.
• This model can improve antibiotic stewardship in ICUs, especially where specialized allergy services are limited.
• Accurate allergy assessment can optimize antibiotic selection and reduce the incidence of resistant infections.