Impact of parent-reported antibiotic allergies on paediatric Antimicrobial Stewardship Programs.

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-01-10 DOI:10.1016/j.jaip.2025.01.007

Annabelle Arnold, Linda L Coventry, Mandie J Foster, Michelle Trevenen, Elizabeth J McKinnon, Sarah MacLindon, Zoy H Goff, Christopher C Blyth, Michaela Lucas

{"title":"Impact of parent-reported antibiotic allergies on paediatric Antimicrobial Stewardship Programs.","authors":"Annabelle Arnold, Linda L Coventry, Mandie J Foster, Michelle Trevenen, Elizabeth J McKinnon, Sarah MacLindon, Zoy H Goff, Christopher C Blyth, Michaela Lucas","doi":"10.1016/j.jaip.2025.01.007","DOIUrl":null,"url":null,"abstract":"Background: Antimicrobial stewardship (AMS) is crucial for optimising antimicrobial use and restraining emergence of antimicrobial resistance. The overall increase in reported antibiotic allergies in children can pose a significant barrier to AMS, but its impact on clinical AMS care in children has not been addressed.Objective: Compare the clinical outcomes for children with a reported antibiotic allergy label (AAL) with those with no AAL reviewed by AMS.Method: A retrospective cohort study conducted in a paediatric tertiary hospital, capturing 1590 inpatient admissions reviewed under the AMS between 2017-2019. Logistic, log-binomial and Cox regression analyses were undertaken. Data collected included documented AAL, antibiotic prescriptions, principal diagnosis, admitting specialty, hospital length of stay, intensive care admissions and hospital readmissions.Results: All 1590 paediatric patients were prescribed at least one antibiotic. AALs were recorded in 6.6% of patients; majority were beta-lactam (82%), mostly penicillins (71%). AALs increased with age (p<0.001); no gender effect was seen. Patients with AALs received more quinolones (p<0.001), lincosamides (p=0.001), aminoglycosides (p<0.001), and metronidazole (p=0.015), than patients with no AALs. In contrast, children with no AAL received more penicillin (p<0.001). Children with any AAL had marginally longer hospital length of stay, median (IQR) 7.0 (4.0, 15.0) days, than those without (median (IQR) 5.0 (3.75, 11.0) days, p=0.027).Conclusion: This study is the first to show how AALs impact clinical outcomes in children under an AMS program. With recent advances in delabelling, early intervention in cases of AAL should target children under AMS services who are in immediate need of optimal antibiotic management.","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jaip.2025.01.007","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Antimicrobial stewardship (AMS) is crucial for optimising antimicrobial use and restraining emergence of antimicrobial resistance. The overall increase in reported antibiotic allergies in children can pose a significant barrier to AMS, but its impact on clinical AMS care in children has not been addressed.

Objective: Compare the clinical outcomes for children with a reported antibiotic allergy label (AAL) with those with no AAL reviewed by AMS.

Method: A retrospective cohort study conducted in a paediatric tertiary hospital, capturing 1590 inpatient admissions reviewed under the AMS between 2017-2019. Logistic, log-binomial and Cox regression analyses were undertaken. Data collected included documented AAL, antibiotic prescriptions, principal diagnosis, admitting specialty, hospital length of stay, intensive care admissions and hospital readmissions.

Results: All 1590 paediatric patients were prescribed at least one antibiotic. AALs were recorded in 6.6% of patients; majority were beta-lactam (82%), mostly penicillins (71%). AALs increased with age (p<0.001); no gender effect was seen. Patients with AALs received more quinolones (p<0.001), lincosamides (p=0.001), aminoglycosides (p<0.001), and metronidazole (p=0.015), than patients with no AALs. In contrast, children with no AAL received more penicillin (p<0.001). Children with any AAL had marginally longer hospital length of stay, median (IQR) 7.0 (4.0, 15.0) days, than those without (median (IQR) 5.0 (3.75, 11.0) days, p=0.027).

Conclusion: This study is the first to show how AALs impact clinical outcomes in children under an AMS program. With recent advances in delabelling, early intervention in cases of AAL should target children under AMS services who are in immediate need of optimal antibiotic management.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.