PMID- 23553999
OWN - NLM
STAT- MEDLINE
DCOM- 20140213
LR  - 20220318
IS  - 1553-5606 (Electronic)
IS  - 1553-5592 (Linking)
VI  - 8
IP  - 6
DP  - 2013 Jun
TI  - The impact of penicillin skin testing on clinical practice and antimicrobial 
      stewardship.
PG  - 341-5
LID - 10.1002/jhm.2036 [doi]
AB  - BACKGROUND: Penicillin skin testing (PST) is a simple and reliable way of 
      diagnosing penicillin allergy. After being off the market for 4 years, 
      penicilloyl-polylysine was reintroduced in 2009 as PRE-PEN. We describe the 
      negative predictive value (NPV) of PST and the impact on antibiotic selection in 
      a sample of hospitalized patients with a reported history of penicillin allergy. 
      METHODS: We introduced a quality improvement process at our 861-bed tertiary care 
      hospital that used PST to guide antibiotic usage in patients with a history 
      consistent with an immunoglobulin E (IgE)-mediated reaction to penicillin. 
      Subjects with a negative PST were then transitioned to a beta-lactam agent for the 
      remainder of their therapy. NPV of skin testing was established at 24-hour 
      follow-up. We are reporting the result of 146 patients tested between March 2012 
      and July 2012. RESULTS: A total of 146 patients with a history of penicillin 
      allergy and negative PST were treated with beta-lactam antibiotics. Of these, only 1 
      subject experienced an allergic reaction to the PST. The remaining 145 patients 
      tolerated a full course of beta-lactam therapy without an allergic response, giving 
      the PST a 100% NPV. We estimated that PST-guided antibiotic alteration for these 
      patients resulted in an estimated annual savings of $82,000. CONCLUSION: Patients 
      with a history of penicillin allergy who have a negative PST result are at a low 
      risk of developing an immediate-type hypersensitivity reaction to beta-lactam 
      antibiotics. The increased use of PST may help improve antibiotic stewardship in 
      the hospital setting.
CI  - Copyright (c) 2013 Society of Hospital Medicine.
FAU - Rimawi, Ramzy H
AU  - Rimawi RH
AD  - Department of Internal Medicine, Division of Infectious Diseases, Brody School of 
      Medicine-East Carolina University, Greenville, NC 27834, USA. 
      ramzyrimawi@hotmail.com
FAU - Cook, Paul P
AU  - Cook PP
FAU - Gooch, Michael
AU  - Gooch M
FAU - Kabchi, Badih
AU  - Kabchi B
FAU - Ashraf, Muhammad S
AU  - Ashraf MS
FAU - Rimawi, Bassam H
AU  - Rimawi BH
FAU - Gebregziabher, Mulugeta
AU  - Gebregziabher M
FAU - Siraj, Dawd S
AU  - Siraj DS
LA  - eng
PT  - Journal Article
DEP - 20130403
PL  - United States
TA  - J Hosp Med
JT  - Journal of hospital medicine
JID - 101271025
RN  - 0 (Anti-Infective Agents)
RN  - 0 (Penicillins)
SB  - IM
CIN - J Hosp Med. 2014 Jan;9(1):71. PMID: 24339391
CIN - J Hosp Med. 2014 Jan;9(1):70. PMID: 24339423
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Infective Agents/*adverse effects
MH  - Drug Hypersensitivity/*diagnosis/*epidemiology/therapy
MH  - Female
MH  - Hospitalization/trends
MH  - Hospitals, Teaching/*methods/standards/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Penicillins/*adverse effects
MH  - Skin Tests/methods/standards/trends
MH  - Young Adult
EDAT- 2013/04/05 06:00
MHDA- 2014/02/14 06:00
CRDT- 2013/04/05 06:00
PHST- 2012/12/27 00:00 [received]
PHST- 2013/02/27 00:00 [revised]
PHST- 2013/02/28 00:00 [accepted]
PHST- 2013/04/05 06:00 [entrez]
PHST- 2013/04/05 06:00 [pubmed]
PHST- 2014/02/14 06:00 [medline]
AID - 10.1002/jhm.2036 [doi]
PST - ppublish
SO  - J Hosp Med. 2013 Jun;8(6):341-5. doi: 10.1002/jhm.2036. Epub 2013 Apr 3.