背景:抗生素过敏标签是治疗和抗菌药物管理的重要障碍,但他们在英国医院的患病率描述不佳。
目的:为了确定英国大型医院环境中抗生素过敏标签的患病率和特征,并估计青霉素过敏标签的比例,对其进行即时护理(POC)去标签评估是合适的。
方法:分析了2019年在剑桥大学医院NHS基金会信托基金接受治疗的所有患者的电子健康记录数据。经过验证的POC去标记风险分层标准被回顾性地应用于青霉素过敏标签。
结果:所有患者中有11.8%(32,148/273,216);住院患者中有16.3%(13,874/85,230),门诊患者中有9.7%(18,274/187,986)。青霉素是描述的最常见的反应沉淀剂(9.0%的患者;24,646/273,216),其次是磺酰胺/甲氧苄啶(1.4%;3,869/273,216)和大环内酯类/林可沙酰胺(1.3%;3,644/273,216)。3.9%的住院患者对>1类抗生素有反应(3,348/85,230)。皮肤表现是最常见的反应特征(40.7%的标记;15,821/38,902)。在描述可能或可能的青霉素“过敏”的15,949个标签中,有足够的细节可以对POC去标签适用性进行回顾性评估,1,702个被认为适合在未经进一步调查的情况下将标签移除或降级为“不容忍”(10.7%),11,887例适用于使用口服青霉素激发(OPC)或事先进行床边皮肤测试的OPC进行POC评估(74.5%),2,360人被确定为不适合任何形式的POC评估(14.8%)。
结论:抗生素过敏标签在英国医院环境中非常普遍。大部分青霉素过敏标签可能适用于POC去标签评估。
Antibiotic allergy labels are important barriers to treatment and antimicrobial stewardship, but their prevalence in UK hospitals is poorly described.
To ascertain the prevalence and characteristics of antibiotic allergy labels in a large UK hospital setting and estimate the proportion of penicillin allergy labels for which point-of-care (POC) delabeling assessment would be appropriate.
Electronic health records data were analyzed from all patients treated at Cambridge University Hospitals NHS Foundation Trust in 2019. Validated POC delabeling risk stratification criteria were retrospectively applied to penicillin allergy labels.
Recorded reactions to antibiotics were present in 11.8% of all patients (32,148 of 273,216), 16.3% of inpatients (13,874 of 85,230), and 9.7% of outpatients (18,274 of 187,986). Penicillins were the commonest reaction precipitant described (9.0% of patients; 24,646 of 273,216), followed by sulfonamides/trimethoprim (1.4%; 3869 of 273,216) and macrolides/lincosamides (1.3%; 3644 of 273,216). A total of 3.9% of inpatients had recorded reactions to >1 antibiotic class (3348 of 85,230). Cutaneous manifestations were the most commonly described reaction features (40.7% of labels; 15,821 of 38,902). Of 15,949 labels describing probable or possible penicillin \"allergy\" with sufficient detail to allow for the retrospective assessment of POC delabeling suitability, 1702 were deemed suitable for removal or downgrading of the label to \"intolerance\" without further investigation (10.7%), 11,887 were appropriate for POC assessment using an oral penicillin challenge (OPC) or OPC with prior bedside skin testing (74.5%), and 2360 were identified as unsuitable for any form of POC assessment (14.8%).
Antibiotic allergy labels are highly prevalent in a UK hospital setting. A large proportion of penicillin allergy labels may be suitable for POC delabeling assessment.