RESUMEN
BACKGROUND: Penicillin "allergy" labels are prevalent but frequently misdiagnosed. Mislabelled allergies are associated with adverse outcomes and increased antimicrobial resistance. With an urgent need to delabel the overwhelming number of mislabelled allergies, non-allergist evaluations have been advocated for low-risk individuals. Despite growing interest in non-allergist-led initiatives; evidence on their effectiveness, safety, and impact by direct comparisons are lacking. OBJECTIVE: We assessed the comparative outcomes of penicillin allergy evaluations conducted by allergists vs. non-allergists. METHODS: A prospective, multi-centre, pragmatic study was conducted at four tertiary hospitals (one allergist- vs. three non-allergist-led) for low-risk penicillin allergy patients in Hong Kong - the Hong Kong Drug Allergy Delabelling Initiative 2 (HK-DADI2). RESULTS: Among 228 low-risk patients who underwent testing (32.9% by allergists, 67.1% by non-allergists), only 14 (6.1%) had positive penicillin allergy testing. Delabelling rates (94.1% vs. 93.3%, p=0.777), positive skin tests (2.6% vs. 2.7%, p=1.000) and drug provocation tests (3.3% vs. 2.7%, p=1.000) were similar between allergists and non-allergists. There were no systemic reactions in either cohort. All patients had significant improvements in health-related quality-of-life (DrHy-Q scores -5.00 vs. -8.33, p=0.072). Non-allergist evaluations had shorter waiting times (0.57 vs. 15.7 months, p<0.001), while allergists required fewer consultations with higher rate of completing evaluations within a single-visit (OR=0.04, p<0.001). CONCLUSION: With training and support, non-allergists can independently evaluate low-risk penicillin allergies. Compared to allergists, evaluation of low-risk penicillin allergy by non-allergists can be comparably effective, safe, and impactful on quality-of-life. More multi-disciplinary partnerships to empower non-allergists to conduct allergy evaluations, should be encouraged.
RESUMEN
BACKGROUND: Bacterial infections are not prevalent among patients hospitalized with COVID-19, while unnecessary prescription of antibiotics was commonly observed. This study aimed to determine the impact of procalcitonin testing on antibiotics prescription in the real-world setting. METHODS: We performed a territory-wide retrospective cohort study involving all laboratory-confirmed patients hospitalized in public hospitals in Hong Kong in 2020 with COVID-19. We determined the prevalence of bacterial co-infections (documented infections within 72 h of admission) and secondary bacterial infections (infections after 72 h of admission) and antibiotics consumption, and the correlation between procalcitonin testing and antibiotics prescription. RESULTS: The cohort included 8666 patients, with mean age 45.3 ± 19.9 years, 48.5% male, and comorbidities in 26.9%. Among 2688 patients with bacterial cultures performed, 147 (5.5%) had bacterial co-infections, and 222 (8.3%) had secondary bacterial infections. Antibiotics were prescribed for 2773 (32.0%) patients during the hospital admission. Procalcitonin tests were performed for 2543 (29.3%) patients. More patients with procalcitonin testing received antibiotics (65.9% vs. 17.9%, p < 0.001). Procalcitonin testing was associated with 5-fold increased risk of antibiotics prescription after adjusting for confounding variables. At hospital level, procalcitonin testing correlated with antibiotics prescription. Patients with procalcitonin level < 0.5 ng/mL had a lower probability of antibiotics initiation and shorter duration of antibiotics therapy. CONCLUSIONS: Procalcitonin testing was not associated with lower prescription of antibiotics. Patients with low procalcitonin level had lower antibiotics exposure, supporting the use of procalcitonin to exclude bacterial infections aiding early stopping of antibiotics among patients hospitalized with COVID-19.
