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A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling 'low risk' patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): Implications for healthcare systems.

التفاصيل البيبلوغرافية
العنوان: A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling 'low risk' patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): Implications for healthcare systems.
المؤلفون: Krishna MT; Institute of Immunology and Immunotherapy, University of Birmingham and Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Electronic address: m.t.krishna@bham.ac.uk., Bhogal R; Department of Pharmacy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Ng BY; Department of Pharmacy, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Kildonaviciute K; Department of Pharmacy, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Jani YH; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust and UCL School of Pharmacy, London, UK., Williams I; Health Services Management Centre, University of Birmingham, Birmingham, UK., Sandoe JAT; Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK., Pollard R; Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Jones N; Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Dunsmure L; Department of Pharmacy, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Powell N; Department of Pharmacy, Royal Cornwall Hospitals NHS Trust, Truro, UK., Hullur C; Department of Anaesthesia, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Balaji A; Acute Medicine Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Moriarty C; Theatres and Anaesthetics Research Team, St James' University Hospital, Leeds Teaching Hospitals, Leeds, UK., Jackson B; Theatres and Anaesthetics Research Team, St James' University Hospital, Leeds Teaching Hospitals, Leeds, UK., Warner A; Allergy UK, Crayford, UK., Daniels R; The UK Sepsis Trust, Walsall, UK., West R; Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK., Thomas C; Department of Anaesthesia, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Misbah SA; Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Savic L; Department of Anaesthesia, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
المصدر: The Journal of infection [J Infect] 2024 Mar; Vol. 88 (3), pp. 106116. Date of Electronic Publication: 2024 Feb 06.
نوع المنشور: Observational Study; Multicenter Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: W.B. Saunders Country of Publication: England NLM ID: 7908424 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2742 (Electronic) Linking ISSN: 01634453 NLM ISO Abbreviation: J Infect Subsets: MEDLINE
أسماء مطبوعة: Publication: Kent, UK : W.B. Saunders
Original Publication: London, New York, Academic Press.
مواضيع طبية MeSH: Drug Hypersensitivity*/diagnosis , Hypersensitivity*, Humans ; Penicillins/adverse effects ; Anti-Bacterial Agents/adverse effects ; Feasibility Studies ; Skin Tests ; Delivery of Health Care
مستخلص: Objective: The huge burden of inaccurate penicillin allergy labels (PALs) is an important driver of antimicrobial resistance. This is magnified by insufficient allergy specialists and lack of 'point-of-care' tests. We investigated the feasibility of non-allergy healthcare professionals (HCPs) delivering direct oral penicillin challenges (DPCs) for penicillin allergy de-labelling.
Methods: This prospective observational study was conducted in three hospitals in England across three settings (acute medical, pre-surgical and haematology-oncology). Patients with a PAL were screened and stratified as low risk/high risk. Low risk patients (non-immune mediated symptoms, benign rash, tolerated amoxicillin since and family history) underwent a DPC.
Results: N = 2257 PALs were screened, 1054 were eligible; 643 were approached, 373 declined, 270 consented and 259 risk stratified (low risk = 155; high risk = 104). One hundred and twenty-six low risk patients underwent DPC, 122 (96.8%) were de-labelled with no serious allergic reactions. Conversion rate from screening-to-consent was 12% [3.3% and 17.9% in acute and elective settings respectively; odds ratios for consent were 3.42 (p < 0.001) and 5.53 (p < 0.001) in haematology-oncology and pre-surgical setting respectively. Common reasons for failure to progress in the study included difficulty in reaching patients, clinical instability/medical reasons, lacking capacity to consent and psychological factors.
Interpretation: DPCs can be delivered by non-allergy HCPs. A high proportion of patients with PALs did not progress in the study pathway. Strategies to deliver DPC at optimal points of the care pathway are needed to enhance uptake. Elective settings offer greater opportunities than acute settings for DPC. The safety and simplicity of DPCs lends itself to adoption by healthcare systems beyond the UK, including in resource-limited settings.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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فهرسة مساهمة: Keywords: Antimicrobial resistance; Direct oral penicillin challenge; High risk; Low risk; Penicillin allergy; Risk stratification
المشرفين على المادة: 0 (Penicillins)
0 (Anti-Bacterial Agents)
تواريخ الأحداث: Date Created: 20240208 Date Completed: 20240319 Latest Revision: 20240327
رمز التحديث: 20240327
مُعرف محوري في PubMed: PMC10961940
DOI: 10.1016/j.jinf.2024.01.015
PMID: 38331329
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-2742
DOI:10.1016/j.jinf.2024.01.015