Improving routine prenatal penicillin allergy testing for reported penicillin allergy

BMJ Open Quality

article

Margaret M Gill¹  Sara Gasner²  Alisha Banken²  Miguel Park³  Amy Weaver⁴  Emily Sharpe⁵  Regan Theiler⁶ 

[1] Family Medicine , Mayo Clinic;Department of Nursing , Mayo Clinic;Division of Allergic Diseases , Mayo Clinic;Department of Quantitative Health Sciences , Mayo Clinic;Department of Anesthesiology and Perioperative Medicine , Mayo Clinic;Department of Obstetrics and Gynecology , Mayo Clinic

关键词: healthcare quality improvement;    obstetrics and gynecology;    primary care;    quality improvement;    antibiotic management;   

DOI  :  10.1136/bmjoq-2022-001859

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Patients with self-reported antibiotic allergies have a higher cost of care, more frequent infections with resistant bacteria and worse health outcomes than patients without antibiotic allergies. Ultimately, less than 5% of patients who report a penicillin allergy have a clinically significant immune-mediated hypersensitivity reaction when tested. As 10%–30% of the population of pregnant patients are colonised for group B Streptococcus (GBS) and guidelines recommend penicillin as the treatment of choice for GBS, current recommendations support penicillin allergy testing in pregnant patients who report an allergy.Methods and intervention In this quality improvement project, nursing staff used an algorithm outlining inclusion and exclusion criteria to determine which patients were eligible to have penicillin allergy testing completed. Penicillin allergy testing consisted of a skin test using benzylpenicilloyl polylysine (Pre-Pen), penicillin G potassium, amoxicillin and alkaline hydrolysis mix (penicilloate) as a prick skin test, followed by intradermal skin test and finally an oral challenge with either amoxicillin or penicillin. Patient outcomes were analysed to evaluate the impact of the intervention.Results Of the 1266 patients receiving prenatal care during the intervention, 236 (19%) reported a history of penicillin allergy, and 212 if these were eligible for testing. 150 of the eligible patients were offered penicillin allergy testing. 101 patients (67%) completed testing and 49 (33%) declined testing. Seven patients (7%) had positive penicillin allergy testing, while 94 patients (93%) had negative penicillin allergy testing and were immediately de-labelled as penicillin allergic. Seventeen of the de-labelled patients subsequently tested positive for GBS colonisation, and all received intrapartum penicillin without adverse events.Conclusions Pursuing penicillin allergy testing for pregnant patients with reported penicillin allergy is a safe and feasible approach, allowing for allergy de-labelling and safe, guideline-driven antimicrobial therapy during subsequent labour and delivery hospitalisations. Cost-effectiveness of the allergy testing and impact on later episodes of care should be further investigated.

【 授权许可】

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