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Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study

Abstract

Objective To evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT).

Design One-year quality improvement study using a before–after design.

Setting Free-standing tertiary care paediatric hospital.

Patients Patients with a reported beta-lactam allergy admitted to the paediatric medicine inpatient unit.

Interventions Following standardised assessment and risk stratification of reported symptoms, patients with a low-risk history were offered an OPT. Beta-lactam allergy labels were removed if a reported history was considered non-allergic or after successful OPT.

Main outcome measures Removal of inappropriate beta-lactam allergy labels.

Results 80 patients with 85 reported beta-lactam allergies were assessed. Median age was 8.1 years (IQR 4.8–12.9) and 34 (42%) were female. The majority (n=55, 69%) had an underlying medical condition. Amoxicillin was the most reported allergy (n=25, 29%). Reported reactions were primarily dermatological (n=65, 77%). Half of participants (n=40) were ineligible for OPT, with equal proportions due to clinical reasons or the nature of the reported reaction. Of the 40 eligible patients, 28 patients (70%) were de-labelled either by history alone (n=10) or OPT (n=18). All OPTs were successful. De-labelling allowed five additional patients (11% of those receiving antibiotics) to receive the preferred beta-lactam. Including patients who were subsequently assessed in the allergy clinic, almost half of all evaluated patients were de-labelled (n=37, 46%).

Conclusions An antimicrobial stewardship programme-led programme using a direct OPT was feasible and safe for expanding beta-lactam allergy de-labelling to paediatric patients admitted to the paediatric medicine inpatient unit.

  • Paediatrics
  • Allergy and Immunology
  • Infectious Disease Medicine

Data availability statement

Data are available upon reasonable request. Deidentified participant data that underlie the results will be available following publication. Researchers who provide a scientifically sound proposal will be allowed access to the aggregate participant data. Proposals should be directed to michelle.science@sickkids.ca or wongj37@mcmaster.ca. These proposals will be reviewed and approved by the investigator and collaborators on the basis of scientific merit.

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