scholarly journals The Safety and Efficacy of an Oral Penicillin Challenge Program in Cancer Patients: A Multicenter Pilot Study

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Jason A Trubiano ◽  
Olivia Smibert ◽  
Abby Douglas ◽  
Misha Devchand ◽  
Belinda Lambros ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Low Risk ◽  
Beta Lactams ◽  
Safety And Efficacy ◽  
Narrow Spectrum ◽  
Oral Penicillin

Abstract Antibiotic allergies are reported by up to 1 in 4 cancer patients, almost 50% of which are considered low risk and precede the cancer diagnosis. We demonstrate the successful and safe implementation of a pilot oral penicillin challenge program for cancer patients with low-risk penicillin allergies, increasing the use of penicillin and narrow-spectrum beta-lactams post-testing.

scholarly journals The Penicillin Allergy Delabeling Program: A Multicenter Whole-of-Hospital Health Services Intervention and Comparative Effectiveness Study

2020 ◽  
Author(s):  
Kyra Y L Chua ◽  
Sara Vogrin ◽  
Susan Bury ◽  
Abby Douglas ◽  
Natasha E Holmes ◽  
...  
Keyword(s):  
Health Services ◽  
Propensity Score Analysis ◽  
Antibiotic Use ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Index Admission ◽  
Relative Risk Ratio ◽  
Antibiotic Prescribing ◽  
Narrow Spectrum ◽  
Oral Penicillin

Abstract Background Penicillin allergies are associated with inferior patient and antimicrobial stewardship outcomes. We implemented a whole-of-hospital program to assess the efficacy of inpatient delabeling for low-risk penicillin allergies in hospitalized inpatients. Methods Patients ≥ 18 years of age with a low-risk penicillin allergy were offered a single-dose oral penicillin challenge or direct label removal based on history (direct delabeling). The primary endpoint was the proportion of patients delabeled. Key secondary endpoints were antibiotic utilization pre- (index admission) and post-delabeling (index admission and 90 days). Results Between 21 January 2019 and 31 August 2019, we assessed 1791 patients reporting 2315 antibiotic allergies, 1225 with a penicillin allergy. Three hundred fifty-five patients were delabeled: 161 by direct delabeling and 194 via oral penicillin challenge. Ninety-seven percent (194/200) of patients were negative upon oral penicillin challenge. In the delabeled patients, we observed an increase in narrow-spectrum penicillin usage (adjusted odds ratio [OR], 10.51 [95% confidence interval {CI}, 5.39–20.48]), improved appropriate antibiotic prescribing (adjusted OR, 2.13 [95% CI, 1.45–3.13]), and a reduction in restricted antibiotic usage (adjusted OR, 0.38 [95% CI, .27–.54]). In the propensity score analysis, there was an increase in narrow-spectrum penicillins (OR, 10.89 [95% CI, 5.09–23.31]) and β-lactam/β-lactamase inhibitors (OR, 6.68 [95% CI, 3.94–11.35]) and a reduction in restricted antibiotic use (OR, 0.52 [95% CI, .36–.74]) and inappropriate prescriptions (relative risk ratio, 0.43 [95% CI, .26–.72]) in the delabeled group compared with the group who retained their allergy label. Conclusions This health services program using a combination of direct delabeling and oral penicillin challenge resulted in significant impacts on the use of preferred antibiotics and appropriate prescribing.

scholarly journals 1787. The Safety and Efficacy of an Oral Penicillin Rechallenge Program in Cancer Patients: A Pilot Multicenter Study

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S506-S506
Author(s):  
Olivia Smibert ◽  
Abby Douglas ◽  
Misha Devchand ◽  
Belinda Lambros ◽  
Wendy Stevenson ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Multicenter Study ◽  
Safety And Efficacy ◽  
Oral Penicillin

scholarly journals Leptin Levels in Lymph Node Aspiration Biopsy is a Predictor of Smoking Tendencies: A Pilot Study

2020 ◽  
Author(s):  
Fares Qeadan ◽  
Rosstin Ahmadian ◽  
Emily Alden ◽  
Erica Pascetti ◽  
Lily Y. Gu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Pilot Study ◽  
High Risk ◽  
Lymph Nodes ◽  
Cancer Diagnosis ◽  
Low Risk ◽  
Hilar Lymph Node ◽  
University Of New Mexico ◽  
Cytokine Profiles ◽  
Significant Difference

Abstract Background: Cytokine profiles have traditionally been explored in serum due to its ease of accessibility and the diagnostic and assessment capabilities in a clinic setting. Utilization of additional cytokine depots, such as hilar lymph nodes, has not thoroughly been explored. In this study, we examined the cytokine profile of mediastinal and hilar lymph node fine needle aspirates to identify markers capable of differentiating high-risk smokers (>30 pack-years) from low-risk smokers (<30 pack-years), independent of current cancer diagnosis. Methods: We used the cytokine profiles of 27 patients from a pro-spective convenience pilot study conducted at the University of New Mexico. Logistic regression analysis was employed.Results: A significant difference in mean cytokine values for Leptin was discovered between patients categorized as low-risk and high-risk pack year smokers (p=0.034). Additionally, mean cytokine values of Leptin did not differ between patients by cancer diagnosis (malignant vs. benign). Our analysis demonstrated Leptin as a fair marker for discriminating between high-risk smokers and low-risk smokers (AUC 0.73). Conclusions: We conclude Leptin is an optimal cytokine to discriminate between high-risk and low-risk smokers. To our knowledge, this is the first study to assess the ability of Leptin to serve as such an indicator via hilar lymph nodes.

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