UTILIZATION OF A HOSPITALIST DRIVEN PENICILLIN SKIN TESTING PROTOCOL TO PROMOTE ANTIBIOTIC STEWARDSHIP

Abstract

<h3>Introduction</h3> Antibiotic resistance is an increasing problem throughout the world. Inappropriate labeling of penicillin allergies results in suboptimal antibiotic selection for patients. Penicillin skin testing is a valuable tool for facilitating a switch to beta-lactam antibiotics. <h3>Methods</h3> A retrospective analysis of all patients with a documented history of penicillin allergy were included in the study from March 2017 to May 2019; a total of 128 patients were included. Analysis involved nature of penicillin allergy and results of penicillin skin test. Benzylpenicilloyl polylysine (PRE-PEN®) tested major determinant, and diluted penicillin G tested minor determinant. The primary outcome of the study is the rate of antibiotic deescalation, and secondary outcome is a comparison of the duration of non beta-lactam therapy in appropriately re-labeled versus non re-labeled subjects (student t-test). <h3>Results</h3> 12 of 128 patients (9.4%) had a negative histamine test and were labeled indeterminate. Of the remaining 116 patients, 111 had a negative test (95.7%) and 5 (4.3%) had a positive test to PRE-PEN ® or dilute penicillin G. 78 of the 111 negative (70.3%) were switched to a narrower spectrum-based antibiotic, and subsequently did not experience allergic reaction. There was a significantly decreased use of vancomycin, aztreonam, carbapenem, fluoroquinolone and clindamycin. There was no significant difference in duration of non beta-lactam therapy in appropriately re-labeled versus non re-labeled subjects (3.6 days vs. 4.25 days; p=0.35). <h3>Conclusion</h3> Our protocol has demonstrated that a penicillin skin testing protocol can substantially reduce broad spectrum antibiotic use and increase antibiotic stewardship.