Methods: This was a prospective observational study of the implementation of an ID fellow managed penicillin allergy service at a large academic medical center. ID fellows received dedicated training at the beginning of the academic year and then evaluated patients under attending supervision. Patient data collected included allergy history, PST results, antibiotic indication, antibiotics received before and after testing. The primary outcome of the study was to assess the impact of the PST service on optimizing antibiotics. Additionally the ID fellows’ satisfaction with the program was evaluated and a survey of PST practices was sent out to all ID fellowship program directors in the United States.
Results: In the first 9 months of the service, 75 patients were assessed for penicillin allergy testing. 65 patients underwent penicillin skin testing with 57 having a valid test; 95% tested negative and antibiotics were changed for 83% of those: 60% received a narrower spectrum therapy, 79% received clinically more effective therapy and 64% received more cost effective therapy. No patient experienced any serious adverse effects related to antibiotics; 3 had a delayed rash. Of the ID fellows who completed the survey, the majority reported competency in performing PST at the end of the 9 months. Of 156 ID fellowship program directors surveyed, 50 responded (32% response rate). Most agreed that over-reporting of penicillin allergy is a problem and that an inpatient PST service involving ID fellows would benefit patient care and antimicrobial stewardship.
Conclusion: Survey results indicate that penicillin allergy skin testing is a valuable service to have available for inpatient use. Our study demonstrates that a penicillin skin testing service can be effectively managed by ID fellows under attending supervision.
U. Buchwald, Alk-Abello: Investigator , Educational grant