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The National Inpatient Penicillin Allergy Database launches
Associate Professor Jason Trubiano, Director of Infectious Diseases, Austin Health
Ten percent of the Australian population have a penicillin allergy, but the situation is actually not that straight forward. In fact, about 90% of that group are not truly allergic to penicillin, which means they are at risk of receiving the wrong treatment.
There’s also the bigger picture to consider. Globally, antibiotic resistance is rising to dangerously high levels, and over-use of antibiotics is a contributing factor.
It’s a complex situation with many factors – a patient might have at one point had an allergic reaction to a specific drug (such as amoxicillin), or experienced a drug side effect that was interpreted as an allergic reaction. They may have been allergic to penicillin as a child but have since outgrown the allergy without knowing, which happens to around 80% of people who experience an allergic reaction to penicillin as children.
Unconfirmed antibiotic allergy results in inappropriate prescribing and increased use of broad-spectrum antibiotics, poor patient outcomes and a financial impact on the health system.
When a patient is admitted to hospital, time is of the essence and a reliable method for assessing a patient’s reported penicillin allergy is an important tool for clinicians.
National Inpatient Penicillin Allergy Database
Having solid data about the current situation regarding the burden of antibiotic allergies, their impact on antibiotic prescribing and modes of antibiotic allergy testing, is key to effective antibiotic use policies and procedures.
Currently, there are no national standards. The National Antibiotic Allergy Network (NAAN) provides a framework for collaborative health services research in antibiotic allergy and part of this action is the formation of a database for inpatient antibiotic allergy testing, known as the National Inpatient Penicillin Allergy Database.
This database will ultimately provide a platform for informing a standardised assessment and oral challenge (i.e. test dose) procedure, and a method for capturing the resulting data, which can then be used for auditing and improving hospital procedures and national policy. This work will potentially provide vital data to inform the National Allergy Strategy and National Allergy Centre for Excellence (NACE) in the future.
The research team has focused specifically on penicillin for the first phases of the National Inpatient Penicillin Allergy database, which includes the development of a smartphone app enabling clinicians to assess penicillin allergy and record the results of an oral challenge test at a patient’s bedside.
To date, the most common method for assessing penicillin allergy has been a paper-based assessment tool. If a patient is assessed as having a low-risk penicillin allergy, they are then offered a test dose to confirm if the allergy truly exists. About 97% of patients given a test dose are found to not have a penicillin allergy.
BioGrid’s secure platform underpins the National Inpatient Penicillin Allergy Database
The National Inpatient Penicillin Allergy Database project team had a choice – build their own database or find a partner with the expertise to help them. Doing it themselves would have cost triple, and BioGrid’s secure data storage and handling, along with existing ethics approval for the platform, made it a compelling proposition.
“BioGrid makes the database very attractive to sites that are considering coming on board, as they tick all the boxes in terms of data security, data storage, the coding of data to remove identifying information, and the governance that exists for the platform,” says Associate Professor Jason Trubiano.
“In addition, the BioGrid relationship presents exciting possibilities in the future to link data from other studies with the National Inpatient Penicillin Allergy database to examine the relationship between penicillin allergy and other health factors.”
The app utilises published clinical assessment tools, such as the Antibiotic Allergy Assessment Tool and PEN-FAST calculator, to provide clinicians with a platform to easily collect penicillin allergy phenotypic data and enable a resultant risk-assessment. The app also allows oral challenge data collection at the point-of-care.
The data collected by the app is not stored locally, but is safely transferred via the cloud to a REDCap database securely hosted by BioGrid.
What’s exciting about partnering with BioGrid is that down the track using data linkage we can look at the impact of penicillin allergy on areas that smaller studies have been unable to do, such as antimicrobial stewardship (AMS) and other health economic outcomes.
National and global Interest expected for the National Inpatient Penicillin Allergy Database and smartphone app
The smartphone app launched in November 2022 at the Austin Hospital, Peter MacCallum Cancer Centre and Albury Wodonga Health, with other sites to commence in early 2023.
The team expects interest in the National Inpatient Penicillin Allergy Database to grow, with more than 40 Australian sites anticipated to be on board by 2024, representing almost 4000 patients. International interest is already apparent, with enquiries from South Africa and New Zealand, and it’s likely the database will expand internationally at the end of 2023.
Associate Professor Trubiano can also see the smartphone app and the database being used in general practice and community health environments in both metropolitan and rural areas.
“We’ve deliberately kept the tool simple so it can be easily embedded in clinical practice, but every site has the ability to extend it and use it for their own projects. For example, they may wish to add admission data or antibiotic adverse events data.”
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