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Low self-reported penicillin allergy in South Africa—implications for global public health response

2022; Oxford University Press; Volume: 5; Issue: 1 Linguagem: Inglês

10.1093/jacamr/dlad015

2632-1823

Cascia Day, Marc Mendelson, Jonny Peter, Maria Deetlefs, Andrew O’Brien, Jenna Smith, Michael Boyd, Nicky Embling, Sabiha Patel, Kirsten Moody, Tokoloho Ramabele, Andrea Budge, T Tarwa, Odwa Jim, Tiara Maharaj, Saabira Pandy, Jean-Michel Abrahams, Angelica Panieri, S Verhage, Matthew van der Merwe, Alexander Geragotellis, Waheed Amanjee, Cameron Joseph, Ziqi Zhao, Salmaan Moosa, Megan Bunting, Yanelisa Pulani, Phumzile Mukhari, Melissa de Paiva, Gcobisa Deyi, Ramses Peigou Wonkam, Nqaba Mancotywa, Andiswa Dunge, Tumi Msimanga, Ashmika Singh, Ofentse Monnaruri, Bokamoso Molale, Thomas Alexander Gugile Butler, Kate Browde, Christiana Müller, Janet Van Der Walt, Richard Whitelaw, Daniel Cronwright, Suniti Sinha, Uvile Binase, Innocent Francis, Darleen Boakye, Sipho Dlamini,

Antimicrobial Resistance in Staphylococcus

In high-income countries, up to 25% of inpatients have a self-reported penicillin allergy (PA). After testing, 95% of these self-reported PAs are incorrect. These incorrectly labelled PAs increase the use of broad-spectrum antibiotics, and drive bacterial resistance. The epidemiology of PA in low- and middle-income countries is unknown. We aimed to describe the epidemiology and delabelling outcomes of self-reported PA in South African (SA) inpatients.We conducted point prevalence surveys between April 2019 and June 2021 at seven hospitals in Cape Town, South Africa. A team trained in the PEN-FAST allergy decision tool conducted in-person interviews, and reviewed patient notes to identify and risk stratify inpatients with a self-reported PA. These patients were referred to the Groote Schuur Hospital (GSH) allergy clinic for delabelling.A total of 1486 hospital inpatients were surveyed and 3.2% (n = 48) carried a PA label. Importantly, 64.6% (n = 31) were classified by PEN-FAST as low risk for true penicillin hypersensitivity. Overall, 25% of the self-reported PAs received a β-lactam antibiotic in hospital and were directly delabelled. Delabelling attrition was very high, with 6.3% (3/48) of the self-reported PAs attending the GSH allergy clinic, and only one patient proceeding to a negative oral penicillin challenge.Inpatient self-reported PA was lower in South Africa hospitals compared with other upper-middle-income countries, and the majority of patients carried a low-risk PA label. Linkage for delabelling with the allergy clinic was very poor, and thus strategies to improve access and delivery of delabelling remains an urgent public health issue.