Evaluation of noted Antibiotic Allergy as an Antimicrobial Stewardship Intervention

Antibiotic allergy Antimicrobial Stewardship Antimicrobial resistance

J.N.G. Oude Elberink
A. Middel

Nature of the research:
Descriptive/prevalence research

Fields of study:
microbiology internal medicine allergology

Background / introduction
Infections due to antibiotic-resistant bacteria are a threat to modern health care and is mainly caused by incorrect or inappropriate use of antimicrobial therapy. One reason for inappropriate antimicrobial therapy are noted allergies to antibiotics, in particular penicillin. Beside a raise in antimicrobial resistance, the use of alternative antimicrobial therapy due to noted antibiotic allergies leads to higher morbidity, mortality and costs. Penicillin is the most common drug allergy noted at hospital admission but most subjects with a history of penicillin allergy are not allergic after evaluation by an allergist and will tolerate future penicillin use. Antimicrobial stewardship programs are worldwide implemented to target the problem of the increasing antimicrobial resistance. One of the interventions to improve appropriate use of antimicrobials is to delabel noted allergies to antimicrobials.
Research question / problem definition
The goal of this project is to evaluate the prevalence of noted drug allergies in general in the electronic patient chart EPIC of the UMCG. Subsequently there will be a specific scope on labeled antibiotic allergy, in particular penicillin allergy. Furthermore labeled antibiotic allergies will be analyzed by classification (eg type I, type IV allergy) and severity of the reactions.
This information will enable us to start the subsequent projects:
- to analyze the financial impact of allergy labels on the budget of the UMCG
- to develop an algorithm on how to import relevant drug allergies in an electronic patient chart in the future.
- To analyze antibiotic allergies in specific patient groups with high susceptibility for infections, for example a (potential) transplantation patient, leading to an intervention strategy for allergy evaluation in this group.
Extraction of noted drug allergy information in the electronic patient system EPIC of the UMCG in general. Subsequently the scope will be on the labeling of antibiotic allergies by severity, antibiotic group and specific drugs in each of these groups.
Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: A cohort study. J Allergy Clin Immunol. 2014 Mar;133(3):790-6. doi:10.1016/j.jaci.2013.09.021. Epub 2013 Nov 1.
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