{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T12:37:22Z","timestamp":1790426242099,"version":"4.1.0"},"reference-count":40,"publisher":"Cambridge University Press (CUP)","issue":"05","license":[{"start":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T00:00:00Z","timestamp":1553644800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X19000503_as1\"><jats:title>Objective:<\/jats:title><jats:p>To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported \u03b2-lactam allergies.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19000503_as2\"><jats:title>Design:<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19000503_as6\"><jats:title>Setting:<\/jats:title><jats:p>Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19000503_as3\"><jats:title>Methods:<\/jats:title><jats:p>We evaluated \u03b2-lactam antibiotic test-dose outcomes, including adverse drug reactions (ADRs), hypersensitivity reactions (HSRs), and electronic health record (EHR) allergy record updates. HSR predictors were examined using a multivariable logistic regression model. Modification of the EHR allergy record after test doses considered relevant allergy entries added, deleted, and\/or specified.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19000503_as4\"><jats:title>Results:<\/jats:title><jats:p>We identified 1,046 test-doses: 809 (77%) to cephalosporins, 148 (14%) to penicillins, and 89 (9%) to carbapenems. Overall, 78 patients (7.5%; 95% confidence interval [CI], 5.9%\u20139.2%) had signs or symptoms of an ADR, and 40 (3.8%; 95% CI, 2.8%\u20135.2%) had confirmed HSRs. Most HSRs occurred at the second (ie, full-dose) step (68%) and required no treatment beyond drug discontinuation (58%); 3 HSR patients were treated with intramuscular epinephrine. Reported cephalosporin allergy history was associated with an increased odds of HSR (odds ratio [OR], 2.96; 95% CI, 1.34\u20136.58). Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19000503_as5\"><jats:title>Conclusion:<\/jats:title><jats:p>This antimicrobial stewardship intervention using \u03b2-lactam test-dose procedures was safe. Overall, 3.8% of patients with \u03b2-lactam allergy histories had an HSR; cephalosporin allergy histories conferred a 3-fold increased risk. Encouraging EHR documentation might improve this safe, effective, and practical acute-care antibiotic stewardship tool.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2019.50","type":"journal-article","created":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T16:23:55Z","timestamp":1553703835000},"page":"528-535","source":"Crossref","is-referenced-by-count":59,"title":["Outcomes from an inpatient beta-lactam allergy guideline across a large US health system"],"prefix":"10.1017","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4773-9817","authenticated-orcid":false,"given":"Kimberly G.","family":"Blumenthal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce T.","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna 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