BACKGROUND: Patients with penicillin allergy admitted to the intensive care unit (ICU) frequently receive non-beta-lactam antimicrobials for the treatment of infection. The use of these antimicrobials, more commonly vancomycin and fluoroquinolones, is associated with the emergence of multidrug-resistant infections. The penicillin skin test (PST) can help detect patients at risk of developing an immediate allergic reaction to penicillin and those patients with a negative PST may be able to use a penicillin antibiotic safely. METHODS: We determined the incidence of true penicillin allergy, the percentage of patients changed to a beta-lactam antimicrobial when the test was negative, the safety of the test, and the safety of administration of beta-lactam antimicrobials in patients with a negative test. Skin testing was performed using standard methodology. RESULTS: One hundred patients admitted to 4 ICUs were prospectively studied; 58 of them were male. The mean age was 63 years. Ninety-six patients had the PST: one was positive (1.04%), 10 (10.4%) were nondiagnostic, and 85 (88.5%) were negative. Of the 38 patients who received antimicrobials for therapeutic reasons, 31(81.5%) had the antibiotic changed to a beta-lactam antimicrobial after a negative reading versus 7 patients of the 57 (12%) who had received a prophylactic antimicrobial (P < .001). No adverse effects were reported after the PST or after antimicrobial administration. CONCLUSIONS: The PST is a safe, reliable, and effective strategy to reduce the use of non-beta-lactam antimicrobials in patients who are labeled as penicillin allergic and admitted to the ICU.
BACKGROUND:Patients with penicillinallergy admitted to the intensive care unit (ICU) frequently receive non-beta-lactam antimicrobials for the treatment of infection. The use of these antimicrobials, more commonly vancomycin and fluoroquinolones, is associated with the emergence of multidrug-resistant infections. The penicillin skin test (PST) can help detect patients at risk of developing an immediate allergic reaction to penicillin and those patients with a negative PST may be able to use a penicillin antibiotic safely. METHODS: We determined the incidence of true penicillinallergy, the percentage of patients changed to a beta-lactam antimicrobial when the test was negative, the safety of the test, and the safety of administration of beta-lactam antimicrobials in patients with a negative test. Skin testing was performed using standard methodology. RESULTS: One hundred patients admitted to 4 ICUs were prospectively studied; 58 of them were male. The mean age was 63 years. Ninety-six patients had the PST: one was positive (1.04%), 10 (10.4%) were nondiagnostic, and 85 (88.5%) were negative. Of the 38 patients who received antimicrobials for therapeutic reasons, 31(81.5%) had the antibiotic changed to a beta-lactam antimicrobial after a negative reading versus 7 patients of the 57 (12%) who had received a prophylactic antimicrobial (P < .001). No adverse effects were reported after the PST or after antimicrobial administration. CONCLUSIONS: The PST is a safe, reliable, and effective strategy to reduce the use of non-beta-lactam antimicrobials in patients who are labeled as penicillinallergic and admitted to the ICU.
Authors: Kimberly G Blumenthal; Erin E Ryan; Yu Li; Hang Lee; James L Kuhlen; Erica S Shenoy Journal: Clin Infect Dis Date: 2018-01-18 Impact factor: 9.079
Authors: Kimberly G Blumenthal; Erica S Shenoy; Anna R Wolfson; David N Berkowitz; Victoria A Carballo; Diana S Balekian; Kathleen A Marquis; Ramy Elshaboury; Ronak G Gandhi; Praveen Meka; David W Kubiak; Jennifer Catella; Barbara B Lambl; Joyce T Hsu; Monique M Freeley; Alana Gruszecki; Paige G Wickner Journal: J Allergy Clin Immunol Pract Date: 2017 May - Jun
Authors: Kimberly G Blumenthal; Paige G Wickner; Shelley Hurwitz; Nicholas Pricco; Alexandra E Nee; Karl Laskowski; Erica S Shenoy; Rochelle P Walensky Journal: J Allergy Clin Immunol Date: 2017-02-28 Impact factor: 10.793
Authors: So Hee Lee; Heung Woo Park; Sae Hoon Kim; Yoon Seok Chang; Sun Sin Kim; Sang Heon Cho; Kyung Up Min; You Young Kim Journal: Korean J Intern Med Date: 2010-06-01 Impact factor: 3.165