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A Prospective Observational Study of the Effect of Penicillin Skin Testing on Antibiotic Use in the Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Mercedes E. Arroliga ,
Christine Radojicic ,
Steven M. Gordon ,
Marc J. Popovich ,
C. Allen Bashour ,
Alton L. Melton  and
Alejandro C. Arroliga
Mercedes E. Arroliga
Affiliation:
Allergy Section, The Cleveland Clinic Foundation, Cleveland, Ohio
Christine Radojicic
Affiliation:
Allergy Section, The Cleveland Clinic Foundation, Cleveland, Ohio
Steven M. Gordon*
Affiliation:
Infectious Disease Department, The Cleveland Clinic Foundation, Cleveland, Ohio
Marc J. Popovich
Affiliation:
Anesthesia Department, The Cleveland Clinic Foundation, Cleveland, Ohio
C. Allen Bashour
Affiliation:
Anesthesia Department, The Cleveland Clinic Foundation, Cleveland, Ohio
Alton L. Melton
Affiliation:
Allergy Section, The Cleveland Clinic Foundation, Cleveland, Ohio
Alejandro C. Arroliga
Affiliation:
Pulmonary and Critical Care Department, The Cleveland Clinic Foundation, Cleveland, Ohio
*
The Cleveland Clinic Foundation, Mailstop S32, Cleveland, OH 44195
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Abstract

Background:

Patients with penicillin allergy admitted to the intensive care unit (ICU) frequently receive non-beta-lactam antimicrobials for the treatment of infection. The use of these antimicrobials, more commonly vancomycin and fluoroquinolones, is associated with the emergence of multidrug-resistant infections. The penicillin skin test (PST) can help detect patients at risk of developing an immediate allergic reaction to penicillin and those patients with a negative PST may be able to use a penicillin antibiotic safely.

Methods:

We determined the incidence of true penicillin allergy, the percentage of patients changed to a beta-lactam antimicrobial when the test was negative, the safety of the test, and the safety of administration of beta-lactam antimicrobials in patients with a negative test. Skin testing was performed using standard methodology.

Results:

One hundred patients admitted to 4 ICUs were prospectively studied; 58 of them were male. The mean age was 63 years. Ninety-six patients had the PST: one was positive (1.04%), 10 (10.4%) were nondiagnostic, and 85 (88.5%) were negative. Of the 38 patients who received antimicrobials for therapeutic reasons, 31(81.5%) had the antibiotic changed to a beta-lactam antimicrobial after a negative reading versus 7 patients of the 57 (12%) who had received a prophylactic antimicrobial (P < .001). No adverse effects were reported after the PST or after antimicrobial administration.

Conclusions:

The PST is a safe, reliable, and effective strategy to reduce the use of non-beta-lactam antimicrobials in patients who are labeled as penicillin allergic and admitted to the ICU.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 5 , May 2003 , pp. 347 - 350
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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