Volume 6 Supplement 2

Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2010

Open Access

Quality of penicillin allergy management in the intensive care unit and internal medicine ward

  • Philippe Bégin1, 2Email author,
  • Matthieu Picard1, 2,
  • Hugues Bouchard1,
  • Jonathan Cloutier1,
  • Émilie Daoust1,
  • Louis Paradis2 and
  • Brian Laufer1
Allergy, Asthma & Clinical Immunology20106(Suppl 2):P1

DOI: 10.1186/1710-1492-6-S2-P1

Published: 4 November 2010

Background

Penicillin allergy is reported by 10% of the population [1]. The associated morbidity is substantial given its medical and economic implications [24]. The aim of this study was to assess the quality of care with regards to the management of penicillin allergy in a university affiliated general hospital with no allergy service.

Material and methods

All admissions from December 1st 2008 to December 1st 2009 were hand reviewed for a notion of penicillin allergy. Files were then assessed for (1) quality of allergic history to penicillin, (2) referral to an allergy clinic upon discharge, (3) indications for such a referral, (4) indication for a beta-lactam, and in the latter case, (5) management of antibiotic therapy.

Results

Of the 1738 files reviewed, 172 contained a notion of alleged penicillin allergy. History of the reaction to penicillin was poorly detailed even when patients required beta-lactam therapy (table 1). In the 87 patients who did require a beta-lactam, half received it without any skin testing, challenge or desensitization. No adverse reaction occurred. The main antibiotics used in the remaining patients were fluoroquinolones and vancomycin. Decision-making concerning the choice of antibiotic was documented in only 18%. Upon discharge, only two patients were referred to an allergy clinic for elective penicillin skin testing, even though referral was strongly indicated in 97 patients (table 2).
Table 1

Details included in allergy history

 

All patients (n=172)

Patients with indication for beta-lactam (n=87)

Allergy to penicillin noted in admission note

139 (81%)

69 (79%)

Allergy tag on file

119 (69%)

66 (76%)

Molecule specified

31 (18%)

23 (26%)

Allergic reaction described

52 (30%)

27 (31%)

Delay since reaction noted

7 (4%)

5 (6%)

Treatment of allergic reaction noted

0

0

Table 2

Strong arguments for allergy referral.

Argument

Number of patient (n=172)

Allergy to a non beta-lactam antibiotic

37 (22%)

Immunosuppressive treatment

15 (9%)

Chronic disease (COPD, CKD on dialysis, complicated diabetes)

85 (49%)

Admitted for acute infection

72 (42%)

Planned surgery

49 (28%)

Any

128 (74%)

Any and survived hospitalisation

97 (56%)

Conclusion

Penicillin allergy is a frequent problem in hospital practice. Its management is not optimal in most cases. This study stresses the importance of continuous medical education on this subject and the importance of a readily available inpatient allergy service to support hospital practitioners.

Authors’ Affiliations

(1)
Department of medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal
(2)
Department of medicine, Centre Hospitalier de l’Université de Montréal

References

  1. Solensky R: Hypersensitivity reactions to beta-lactam antibiotics. Clin Rev Allergy Immunol. 2003, 24: 201-20. 10.1385/CRIAI:24:3:201.View ArticlePubMedGoogle Scholar
  2. Lee CE: The incidence of antimicrobial allergies in hospitalized patients: implications regarding prescribing patterns and emerging bacterial resistance. Arch Intern Med. 2000, 160: 2819-22. 10.1001/archinte.160.18.2819.View ArticlePubMedGoogle Scholar
  3. MacLaughlin EJ, Saseen JJ, Malone DC: Costs of beta-lactam allergies: selection and costs of antibiotics for patients with a reported beta-lactam allergy. Arch Fam Med. 2000, 9: 722-6. 10.1001/archfami.9.8.722.View ArticlePubMedGoogle Scholar
  4. Martinez LA: Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med. 2003, 163: 1905-12. 10.1001/archinte.163.16.1905.View ArticlePubMedGoogle Scholar

Copyright

© Bégin and Picard; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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