PENICILLIN SKIN TESTING: IS THERE A ROLE WITHIN AN ANTIMICROBIAL STEWARDSHIP PROGRAM?

Objective. Determine the utility and safety of penicillin skin testing (PST) as a potential tool to improve antibiotic use Background. Penicillin allergies are reported by about 10% of patients, although self-reported allergic reactions are often inaccurate and not reflective of a true IgE-mediated allergy. Consequently, the presence of a beta-lactam allergy is associated with twice the use of vancomycin and fluoroquinolones (FQs). As the progression of MDROs and lack of novel antibiotics move us closer towards a potential post-antibiotic era, it is paramount to preserve the longevity of current therapeutic agents. One unique method that may decrease the use of second-line antibiotics while facilitating access to a preferred beta-lactam regimen is a PST. Methods. A literature search was conducted using Pubmed to identify all studies evaluating the use of a PST. Original research articles were reviewed and studies that focused on the institutional use of PSTs were analyzed. Outcomes investigated included number of patients skin tested, results of skin tests, impact of skin testing on antibiotic use, and adverse effects. Results. A total of 2,335 patients with a history of a beta-lactam allergy were administered a PST. Allergy history consisted primarily of unknown and skin manifestations, but multiple studies included patients with a history of anaphylaxis. 74 PSTs were performed by a variety of clinicians, including pharmacists. Negative PSTs were seen in 92% of patients. Following a PST, antibiotic regimens were changed to a beta-lactam in 40-100% of hospitalized patients, including up to 100% of patients receiving vancomycin or FQs. Overall, skin testing was well tolerated. Conclusion. Treatment of infections due to MDROs becomes increasingly complex when beta-lactams are eliminated as a therapeutic option. Current literature supports the role of a PST within various practice settings as an intervention to reduce the use of alternative antibiotics. Grants. Non