Background: Antibiotic allergy evaluation is an important antibiotic stewardship intervention, but is less commonly integrated into inpatient oncology care. Our objective was to evaluate the acceptability and feasibility of a pharmacist-driven penicillin allergy delabeling intervention for patients with hematologic malignancy (HM). Methods: We conducted a cross-sectional survey of physicians and advanced practice providers (APPs) who care for patients with HM at the Hospital of the University of Pennsylvania. The survey was administered from March 2025 to September 2025 in preparation for a planned Allergy Delabeling in Antibiotic Stewardship (RENEW) intervention. The survey included questions on current allergy evaluation practices, the perceived safety of RENEW and validated acceptability of intervention measure (AIM) and feasibility of intervention measure (FIM). AIM and FIM consist of 4 items scored 1-5 and is reported as a mean total score (5-20), with higher scores indicating greater acceptability and feasibility. Data were analyzed using descriptive statistics. Result: Of 70 eligible prescribers, 27 (38.6%) completed the survey: 21 (77.7%) physicians and 6 (22.2%) APPs. The majority (20, 74.1%) reported assessing documented antibiotic allergies of HM patients on admission and at the time an antibiotic is required (25, 92.6%). Nineteen (70.4%) respondents were comfortable modifying a documented antibiotic allergy in the medical record based on their assessment, while just under half (13, 48.1%) were comfortable deleting the allergy in the record based on their assessment. Nineteen (70.4%) respondents felt that penicillin skin testing was safe in patients with HM while 8 (29.6%) were not sure. Over half (14, 51.9%) were unsure if it is safe to evaluate penicillin allergy using an oral challenge based on clinical history without a skin test. The majority (22, 81.5%) said they would be comfortable having a patient’s antibiotic allergy removed from the medical record following negative allergy testing in the RENEW intervention. Compared to other patient safety initiatives, 24 (88.9%) believed evaluating documented antibiotic allergies is important or very important. Mean totals (SD; range) for acceptability and feasibility of the RENEW intervention were AIM, 17.2 (3.5; 8-20) and FIM, 17.7 (3.1; 8-20). Conclusion: Although the low response rate may limit generalizability, the majority of inpatient oncology clinicians perceived that a penicillin allergy delabeling intervention for patients with HM was acceptable and feasible to implement. Overall, clinicians believed that evaluating antibiotic allergy labels in patients with HM is an important and safe initiative, yet there was some uncertainty regarding the safety of a direct oral challenge.
Background: During the 2024 national shortage of BD BACTEC blood culture bottles, many hospitals implemented ordering restrictions to conserve supplies. While prior studies have evaluated overall blood culture utilization and patient outcomes, less is known about how such restrictions affected the observed epidemiology of bloodstream infections (BSIs) across organism groups. Understanding these effects is important for interpreting surveillance data and anticipating downstream clinical implications during diagnostic supply disruptions. Methods: We conducted an interrupted time series analysis of BSI episodes at two tertiary-care hospitals from June 26, 2023 through June 25, 2025. A systemwide electronic order restriction implemented from June 26, 2024 through December 23, 2024 limited clinicians to one blood culture set per patient every 24 hours. We grouped blood culture results into episodes and categorized by organism group. Outcomes included organism group-specific episode incidence, hospital outcomes (e.g., in-hospital mortality/hospice discharge), and blood culture utilization. We used segmented regression models with Newey-West standard errors to estimate level and slope changes associated with restriction onset and withdrawal. Results: We identified 5,391 BSI episodes among 4,484 patients, with baseline characteristics stable across study periods (Table 1). Organism group incidence, hospital outcomes, and blood culture utilization varied by period (Table 2). During the restriction period, the relative incidence of enterococci, fungi, gram negative rods, and Staphylococcus aureus/lugdunensis increased, while anaerobes, streptococci, coagulase-negative staphylococci/common commensals, and polymicrobial infections decreased (Figure 1). Interrupted time series analyses demonstrated an overall decrease in BSI incidence during the restriction, with declines for gram negative rods, streptococci, coagulase-negative staphylococci/common commensals, and polymicrobial infections (Figure 2). We observed statistical significance only for a 51.7% decrease in streptococci incidence upon restriction onset (P=.04) and a 3.5% per month decrease in gram negative rod incidence during restriction (P=.02) (Table 3). Estimates for other organism groups were limited by small numbers of observations, resulting in imprecise effect estimates or potentially artifactual findings. Conclusions Single-set blood culture restriction during the 2024 national supply shortage was associated with changes in the observed epidemiology of BSIs, including an overall decrease in incidence and heterogeneous effects across organism groups. Although interrupted time series analyses for several groups were limited by low power, combined visual and quantitative findings suggest that restrictive diagnostic practices may differentially affect BSI detection by organism type. These findings underscore the need for cautious interpretation of surveillance data during diagnostic disruptions and highlight the importance of resilient diagnostic supply chains and evidence-based mitigation strategies.
Background: The epidemiology of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in hospitalized patients in low- and middle-income countries (LMICs) is poorly described. Although risk factors for ESCrE clinical infection have been studied, little is known of the epidemiology of ESCrE colonization. Identifying risk factors for ESCrE colonization, which can predispose to infection, is therefore critical to inform antibiotic resistance reduction strategies. Methods: This study was conducted in 3 hospitals located in 3 districts in Botswana. In each hospital, we conducted ongoing surveillance in sequential units hospitalwide. All participants had rectal swabs collected which were inoculated onto chromogenic media followed by confirmatory testing using MALDI-TOF MS and VITEK-2. Data were collected via interview and review of the inpatient medical record on demographics, comorbidities, antibiotic use, healthcare exposures, invasive procedures, travel, animal contact, and food consumption. Participants with ESCrE colonization (cases) were compared to noncolonized participants (controls) using bivariable and multivariable analyses to identify risk factors for ESCrE colonization. Results: Enrollment occurred from January 15, 2020, to September 4, 2020, and 469 participants were enrolled. The median age was 42 years (IQR, 31–58) and 320 (68.2%) were female. The median time from hospital admission to date of sampling was 5 days (IQR, 3–12). There were 179 cases and 290 controls (ie, 38.2% of participants were ESCrE colonized). Independent risk factors for ESCrE colonization were a greater number of days on antibiotic, recent healthcare exposure, and tending swine prior to hospitalization. (Table). Conclusions: ESCrE colonization among hospitalized patients was common and was associated with several exposures. Our results suggest prior healthcare exposure may be important in driving ESCrE. The strong link to recent antibiotic use highlights the potential role of antibiotic stewardship interventions for prevention. The association with tending swine suggests that animal husbandry practices may play a role in community exposures, resulting in colonization detected at the time of hospital admission. These findings will help to inform future studies assessing strategies to curb further emergence of hospital ESCrE in LMICs.
Disclosures: None
