Introduction of a Penicillin Allergy De-Labelling Program with Direct Oral Challenge is Associated with Increased Downstream Utilization of Beta-Lactam Antimicrobials: A Multicenter Parallel Cohort Study with Crossover Evaluation
Bibliographic record
Abstract
ABSTRACT Background Penicillin allergy labels are common and are often inaccurate. These labels can lead to unnecessary use of second-line non-beta-lactam antibiotics, and worse clinical outcomes. Objectives We measured the impact of the introducing of a standardized proactive penicillin allergy de-labelling program with oral amoxicillin challenge on subsequent antibiotic use. Methods We performed a retrospective comparison of parallel cohorts from two separate tertiary care hospital campuses across two penicillin de-labelling intervention periods. Outcomes included data including penicillin allergy label and antibiotic use, were collected for the index admission and the subsequent 6-month period. Descriptive statistics as well as multivariate regression analyses were performed. Results A total of 368 patients with penicillin allergy label were included across two campuses and study periods. 24 (13.8%) patients in the intervention group sustained penicillin allergy label at 30 days from admission vs. 3 (1.5%) in the non-intervention group (p < 0.001). In the 6-months following admission, beta-lactams were prescribed more frequently in the intervention groups vs. the non-intervention groups for all patients (28 [16.1%] vs 15 [7.7%], p= 0.04) and for only those patients who received antibiotics (28/46 [60.9%] vs. 15/40 [37.5%], p=0.097). In a multivariate analysis, the intervention was found to be associated with an increased odds of beta-lactam prescribing in all patients (OR 2.49, 95% CU 1.29-5.02) and in those prescribed at least one antibiotic (OR 2.44, 95% CI 1.00-6.15). There were no differences in overall antibiotic prescribing by intervention and non-intervention group during admission (113 [64.9%] vs. 112 [57.7%]) or within 6-months (46 [26.4%] vs. 40 [20.6%]). No drug related adverse events were reported. Conclusions Proactive penicillin allergy de-labelling for inpatients was associated with a reduced number of penicillin allergy labels and increased utilization of beta-lactam vs. other antibiotics in the subsequent 6-months. Capsule Summary A proactive systematic approach to antibiotic allergy de-labelling for inpatients with penicillin allergy label results in an increased number of patients de-labelled at hospital discharge and increased beta-lactam use in the subsequent 6 months.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".