• Salma Alamin, Rachel Egan, Barbara Cusack, Amanda Sherwin, Emily Naylor, Fiona Carroll, E WardMarieMHealth Systems Learning and Research, Quality and Safety Improvement Directorate, St. James's Hospital, Dublin, Ireland., Mary Kelly, Deirdre Doyle, Ignacio Martin-Loeches, Niall Conlon, and Sean Keane.
• Department of Immunology, St. James's Hospital, Dublin, Ireland.
• J Crit Care. 2025 Feb 1; 85: 154977154977.

PurposeCritically ill patients in the intensive care unit (ICU) are frequently prescribed antibiotics, with many reporting an antibiotic allergy label, predominantly to penicillin. Mislabeling contributes to suboptimal antibiotic use, increasing multidrug-resistant organisms and Clostridium difficile infections, and increased hospital length of stay. This prospective study implemented an antibiotic allergy assessment and testing program in the ICU, independently of clinical immunology/allergy services.Materials And MethodsTrained ICU staff prospectively identified and risk assessed eligible patients as having a non-immune mediated drug reaction, or a low, intermediate or high risk antibiotic allergy. Non-immune mediated reactions were directly de-labeled. Low-risk allergies underwent direct drug provocation testing, while intermediate-risk allergies included skin testing followed by drug provocation testing. High-risk allergies were confirmed without testing.ResultsOf 71 eligible patients, 62 underwent assessment. Antibiotic allergy de-labeling occurred in 48 of 51 patients (94 %) with a non-immune, low or intermediate risk allergy. High risk allergies were confirmed in 11 patients (18 %). The study resulted in increased penicillin use and decreased broad-spectrum antibiotic use. No adverse events occurred from testing.ConclusionsThis study shows the feasibility of ICU led antibiotic allergy assessment and testing, highlighting a potential model for implementation in settings lacking immunology/allergy services.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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