Beta-lactam allergy risk stratification in a maternity population in Australia: Scope for allergy de-labelling.

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Wirawan Jeong, Shahad Saleh, Sharon Heap, Vi Pham, Laura Leung, Sushena Krishnaswamy
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引用次数: 0

Abstract

Background: Unconfirmed beta-lactam allergy in pregnant people has been associated with higher morbidity, unnecessary exposure to broad-spectrum antibiotics and prolonged hospitalisation. There are no published data on beta-lactam allergies in pregnant people in Australia.

Aims: The aim was to describe patient-reported beta-lactam allergies and appropriateness for antibiotic allergy de-labelling in a maternity cohort in Australia.

Methods: Maternity patients aged ≥18 years admitted to our institution between March 2021 and June 2021 with a beta-lactam allergy documented in their electronic medical record were interviewed for details of their allergy. The documented allergies were compared to the allergy history obtained from the interview. Severity of the allergy was rated, and appropriateness for allergy de-labelling was assessed using the Victorian Therapeutics Advisory Group beta-lactam antibiotic allergy assessment tool.

Results: One hundred and fifty-three beta-lactam allergies (182 reactions) were reported by 145 patients. Penicillin class antibiotics were the most frequently implicated, including unspecified penicillins (95/153, 62%), amoxicillin (19/153, 13%) and amoxicillin-clavulanate (8/153, 5%). Allergy documentation required amending in 52 of 145 patients (36%); 85 of 153 (56%) of the beta-lactam allergies were considered low risk and potentially appropriate for direct oral re-challenge.

Conclusion: Beta-lactam allergies were inaccurately documented in more than one third of the maternity patients included in our study. As such, education of maternity care providers about the importance of accurate allergy history taking remains an urgent unmet need. Furthermore, allergy assessment and de-labelling during pregnancy should be considered in maternity patients to optimise antibiotic prescribing and to improve maternal and neonatal health outcomes.

澳大利亚孕产妇的β-内酰胺过敏风险分层:消除过敏标签的范围。
背景:未经证实的孕妇β-内酰胺过敏与较高的发病率、不必要地使用广谱抗生素和延长住院时间有关。目的:本研究旨在描述澳大利亚孕产妇队列中患者报告的β-内酰胺类药物过敏情况以及抗生素过敏去标签的适宜性:我们对 2021 年 3 月至 2021 年 6 月期间在本院住院的年龄≥18 岁且电子病历中记录有 beta-内酰胺过敏的孕产妇进行了访谈,以了解他们的过敏详情。将记录的过敏史与访谈中获得的过敏史进行比较。使用维多利亚州治疗咨询小组的β-内酰胺类抗生素过敏评估工具对过敏的严重程度进行评级,并评估是否适合去除过敏标签:145名患者报告了153例β-内酰胺类抗生素过敏(182例反应)。青霉素类抗生素最常见,包括未指定的青霉素类(95/153,62%)、阿莫西林(19/153,13%)和阿莫西林-克拉维酸(8/153,5%)。145名患者中有52名(36%)需要修改过敏记录;153名患者中有85名(56%)的β-内酰胺过敏被认为是低风险,可能适合直接口服再挑战:结论:在我们的研究中,超过三分之一的孕产妇对β-内酰胺过敏的记录不准确。因此,对孕产妇护理人员进行有关准确记录过敏史重要性的教育仍是一项亟待解决的问题。此外,应考虑对孕产妇患者进行过敏评估和孕期去标签化,以优化抗生素处方,改善孕产妇和新生儿的健康状况。
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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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