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Penicillin allergy delabeling in a German University Hospital-implementation in inpatient settings: the PenGuin Pilot
Hannah Nürnberg1,2, Katrin Hörth3, Kristin Egenberger3
1Hospital Pharmacy, University Hospital Heidelberg, Heidelberg, Germany. Hannah.nuernberg@med.uni-heidelberg.de.
Background:
Penicillin allergy (PenA) is reported in up to 15% of hospitalized patients, although true IgE-mediated hypersensitivity is rare. PenA delabeling is an important antimicrobial stewardship intervention, as mislabeling is associated with adverse clinical outcomes. While structured delabeling interventions are safe and effective, their translation into routine care across different healthcare settings remains unclear.
Methods:
This prospective implementation study was conducted on four wards of a 2600-bed German tertiary care center. All adult inpatients with reported PenA underwent structured allergy assessment and risk stratification by clinical pharmacists. Low risk patients were delabeled directly, while moderate-risk patients were evaluated for direct oral challenge (DOC). Outcomes included delabeling rate at discharge, ward-specific differences, and implementation barriers and facilitators assessed by staff questionnaires. Sustainability was evaluated by primary care follow-up 32 weeks after discharge.
Results:
Among 2890 screened patients, 179 (6.2%) reported a PenA. Of 162 eligible patients, 54 (33.3%) were successfully delabeled. DOC was well tolerated, with only one mild skin reaction observed. Ward-specific environments influenced the use of different delabeling strategies. Key barriers included staffing shortages, short hospital stays, and patient-related factors, whereas facilitators included easy integration into pharmacist workflows and interprofessional collaboration. Follow-up showed limited transfer of delabeling outcomes to primary care, reducing long-term sustainability.
Conclusion:
Pharmacist-led PenA delabeling can be safely integrated and is feasible within existing clinical workflows. However, real-world implementation barriers and incomplete transfer to primary care limited its full potential. Improve standardized documentation and cross-sector communication are important for sustainable and widespread implementation of delabeling strategies.
Insights
Pharmacist-led penicillin allergy (PenA) delabeling is feasible in hospitals. However, implementation barriers and poor primary care transfer limit its full potential for antimicrobial stewardship.
Area of Science:
- Implementation Science
- Antimicrobial Stewardship
- Clinical Pharmacy
Background:
- Penicillin allergy (PenA) is overreported, leading to unnecessary broad-spectrum antibiotic use.
- Mislabeling PenA is linked to adverse outcomes and hinders effective antimicrobial stewardship.
- Structured delabeling interventions show promise but real-world implementation is unclear.
Purpose of the Study:
- To assess the feasibility and outcomes of pharmacist-led penicillin allergy delabeling in a tertiary care setting.
- To identify barriers and facilitators to implementing delabeling strategies into routine clinical workflows.
- To evaluate the sustainability of delabeling efforts through primary care follow-up.
Main Methods:
- Prospective implementation study on four hospital wards.
- Clinical pharmacists performed allergy assessment and risk stratification.
- Low-risk patients were delabeled directly; moderate-risk patients underwent direct oral challenge (DOC).
- Implementation barriers and facilitators were assessed via staff questionnaires.
- Sustainability evaluated by primary care follow-up at 32 weeks post-discharge.
Main Results:
- Of 162 eligible patients with reported PenA, 54 (33.3%) were successfully delabeled.
- Direct oral challenge (DOC) was safe, with one mild reaction.
- Ward-specific factors influenced delabeling strategy use.
- Barriers included staffing, short stays, and patient factors; facilitators included workflow integration and collaboration.
- Limited transfer of delabeling outcomes to primary care impacted long-term sustainability.
Conclusions:
- Pharmacist-led PenA delabeling is safe and feasible within hospital workflows.
- Implementation barriers and incomplete primary care transfer limit widespread adoption.
- Standardized documentation and cross-sector communication are crucial for sustainable delabeling.
