title: Antimicrobial allergy 'labels' drive inappropriate antimicrobial prescribing: lessons for stewardship.
abstract: The presence of antimicrobial allergy designations ('labels') often substantially reduces prescribing options for affected patients, but the frequency, accuracy and impacts of such labels are unknown.
  
  
  
  The National Antimicrobial Prescribing Survey (NAPS) is an annual de-identified point prevalence audit of Australian inpatient antimicrobial prescribing using standardized definitions of guideline compliance, appropriateness and indications. Data were extracted for 2 years (2013-14) and compared for patients with an antimicrobial allergy label (AAL) and with no AAL (NAAL).
  
  
  
  Among 21 031 patients receiving antimicrobials (33 421 prescriptions), an AAL was recorded in 18%, with inappropriate antimicrobial use significantly higher in the AAL group versus the NAAL group (OR 1.12, 95% CI 1.05-1.22, P < 0.002). Patterns of antimicrobial use were significantly influenced by AAL, with lower β-lactam use (AAL versus NAAL; OR 0.47, 95% CI 0.43-0.50, P < 0.001) and higher quinolone (OR 2.07, 95% CI 1.83-2.34, P < 0.0001), glycopeptide (OR 1.59, 95% CI 1.38-1.83, P < 0.0001) and carbapenem (OR 1.74, 95% CI 1.43-2.13, P < 0.0001) use. In particular, among immunocompromised patients, AAL was associated with increased rates of inappropriate antimicrobial use (OR 1.68, 95% CI 1.21-2.30, P = 0.003), as well as increased use of quinolones (OR 1.88, 95% CI 1.16-3.03, P = 0.02) and glycopeptides (OR 1.82, 95% CI 1.17-2.84, P = 0.01).
  
  
  
  AALs are common and appear to be associated with higher rates of inappropriate prescribing and increased use of broad-spectrum antimicrobials. Improved accuracy in defining AALs is likely to be important for effective antimicrobial stewardship (AMS), with efforts to 'de-label' inappropriate AAL patients a worthwhile feature of future AMS initiatives.
authors.affiliation: Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia jason.trubiano@austin.org.au.
authors.forename: J A
authors.initials: JA
authors.lastname: Trubiano
authors.affiliation: NHMRC National Centre of Antimicrobial Stewardship, Peter Doherty Institute, Parkville, VIC, Australia Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Epidemiology & Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: Cheng
authors.affiliation: Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Grayson
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Slavin
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia NHMRC National Centre of Antimicrobial Stewardship, Peter Doherty Institute, Parkville, VIC, Australia Department of Infectious Diseases, Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: K A
authors.initials: KA
authors.lastname: Thursky
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001315:Australia; D004342:Drug Hypersensitivity; D004348:Drug Labeling; D011307:Drug Prescriptions; D004363:Drug Utilization; D006801:Humans; D007297:Inpatients; D010818:Practice Patterns, Physicians'
chemical_list: D000890:Anti-Infective Agents