Delabeling Antibiotic Allergy in the Solid Organ Transplant Population Using a Multiple Antibiotic Allergy Evaluation Strategy.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-09-11 DOI:10.1111/tid.70099

Rebecca Lee, Grace Koo, Matthew S Krantz, Christine Allocco, Elizabeth J Phillips, Cosby A Stone

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引用次数: 0

Abstract

Background: First-line antibiotics, such as penicillins, cephalosporins, and sulfonamides, are critical for preventing infections in immunocompromised solid organ transplant (SOT) patients. However, many patients are labeled with multiple antibiotic allergies (AALs) prior to transplant, increasing their risk of adverse outcomes. Because these patients often travel long distances and follow complex care plans, minimizing the number of drug allergy clinic (DAC) visits is important to avoid disruption and improve care continuity.

Methods: We conducted a retrospective cohort study of SOT patients evaluated at Vanderbilt University Medical Center outpatient DAC between 2014 and 2024. We assessed the efficacy, feasibility, and efficiency of a multiple antibiotic allergy evaluation strategy (MAAES), where patients with two or more low-risk AALs underwent consolidated evaluation, testing, and oral challenges, with the goal of delabeling as many as three AALs in a single visit.

Results: Among 184 SOT patients referred for evaluation, the median age was 57 years (IQR 47, 64); 112/184 (61%) were female, and 64/184 (35%) traveled from out-of-state. A total of 53 patients (29%) had two or more first-line AALs. Of these, 49 (93%) had labels successfully removed during their visit: 37 penicillin, 25 cephalosporin, and 24 sulfa allergy labels were delabeled. MAAES reduced the number of required visits to address these AALs by 61%.

Conclusions: MAAES enabled safe, efficient, and consolidated AAL evaluation and removal in SOT patients. In 57% of patients with ≥ 2 first-line AALs, all were safely delabeled in a single clinic visit, improving care efficiency and antibiotic access.

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使用多种抗生素过敏评估策略在实体器官移植人群中去除抗生素过敏标签。

背景：一线抗生素，如青霉素、头孢菌素和磺胺类药物，对于预防免疫功能低下的实体器官移植（SOT）患者感染至关重要。然而，许多患者在移植前被标记为多种抗生素过敏（AALs），增加了他们不良后果的风险。由于这些患者经常长途跋涉并遵循复杂的护理计划，因此减少药物过敏诊所（DAC）的访问量对于避免中断和提高护理连续性非常重要。方法：我们对2014年至2024年在范德比尔特大学医学中心门诊DAC评估的SOT患者进行回顾性队列研究。我们评估了多种抗生素过敏评估策略（MAAES）的疗效、可行性和效率，对患有两种或两种以上低风险AALs的患者进行综合评估、测试和口腔挑战，目标是在一次就诊中去除多达三种AALs的标签。结果：184例SOT患者转介评估，中位年龄为57岁（IQR 47,64）；112/184（61%）为女性，64/184（35%）来自外州。共有53例（29%）患者有2例或2例以上的一线AALs。其中，49种（93%）的标签在就诊期间被成功删除：37种青霉素、25种头孢菌素和24种磺胺过敏标签被删除。MAAES将解决这些急性脑损伤所需的就诊次数减少了61%。结论：MAAES在SOT患者中实现了安全、有效和巩固的AAL评估和清除。在57%的≥2例一线AALs患者中，所有患者在一次就诊中都安全地去标签，提高了护理效率和抗生素的可及性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.