Safety and outcomes of penicillin allergy evaluation in pregnant women.

BACKGROUND: Penicillin allergy in pregnancy is associated with increased morbidity and the use of less effective antibiotics. Penicillin allergy evaluation in pregnancy is now recommended as per obstetrical guidelines but remains infrequent. OBJECTIVE: We studied pregnant women who underwent penicillin allergy evaluation in an allergy clinic to assess the effectiveness and safety of penicillin skin testing (PST) and incremental drug challenge (IDC) in pregnancy. METHODS: Index drug reactions, PST, and IDC results were reviewed. Antibiotic use, pregnancy outcomes, and pregnancy complications were compared with a control cohort of pregnant women with penicillin allergy who did not undergo allergy evaluation before delivery. RESULTS: Penicillin allergy was evaluated in 136 women. Culprit drugs included penicillin (37%), amoxicillin (30%), and unknown (20%). Index reactions occurred greater than 5 years ago in 91%, and these reactions were cutaneous or unknown in 92%. Of the 133 patients who underwent skin testing, 131 (99%) had negative or equivocal results and proceeded to incremental challenge. All 131 women passed penicillin IDC. Of the 69 women who ultimately used intrapartum beta-lactam antibiotics, all but 1 patient tolerated them. Women who underwent penicillin allergy evaluation did not have an increased risk of cesarean delivery or other pregnancy complications when compared with women without penicillin allergy evaluation. CONCLUSION: PST and IDC can be safely conducted in pregnant women. When evaluated as low risk, most women tolerate IDC and can receive penicillin intrapartum without adverse reactions or negative pregnancy outcomes.

Penicillin allergy evaluation in hospitalized patients with hematologic malignancy.

A penicillin allergy testing service (PATS) assessed penicillin allergy in patients with hematologic malignancies; 17 patients who met criteria had negative skin testing. Patients who underwent penicillin challenge passed and were delabeled. Of delabeled patients, 87% received and tolerated ß-lactams during follow-up. Providers found the PATS valuable.

A case-control study of length of stay outliers.

OBJECTIVES: Inpatients with extended length of stay (LOS), referred to as LOS outliers, pose a challenge to health systems by contributing to high costs while assuming all the risks associated with hospital-acquired conditions. Limited research has been conducted within the US health system to better define LOS outliers and the risk factors for becoming an outlier in the setting of inpatient medicine stays. STUDY DESIGN: This was a retrospective study on adult inpatient admissions to the general medicine service of a university hospital from September 2015 to August 2016. Cases were defined as patients with observed LOS 3 SD above predicted. Controls were defined as those who stayed within 3 SD of predicted LOS. METHODS: A total of 108 LOS outliers were identified through the University Health System Consortium, and 72 were matched with inlier controls by principal diagnosis and disease severity. RESULTS: Compared with their inlier controls, outliers stayed 32.41 days longer and cost $77,228 more per stay. There were higher odds of being an outlier observed for patients with a history of smoking (odds ratio [OR], 29.5; 95% CI, 2.9-301.3), in-hospital complications (OR, 17.6; 95% CI, 3.5-88.6), hospital-acquired infections (OR, 7.2; 95% CI, 1.7-31.4), and discharge to a facility (OR, 11.5; 95% CI, 2.6-50.0). CONCLUSIONS: In-hospital complications, hospital-acquired infections, and discharge to a facility are all predictors of not only increasing hospital days for patients but also increasing the risk of becoming LOS outliers, who stay disproportionately longer and use disproportionately more resources than predicted.