Self-reported beta-lactam allergy in government and private hospitals in Cape Town, South Africa

Authors

  • C Day Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
  • M Deetlefs Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
  • A O’Brien Faculty of Health Sciences, University of Cape Town, South Africa
  • J Smith Faculty of Health Sciences, University of Cape Town, South Africa
  • M Boyd Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • N Embling Faculty of Health Sciences, University of Cape Town, South Africa
  • S Patel Faculty of Health Sciences, University of Cape Town, South Africa
  • K Moody Faculty of Health Sciences, University of Cape Town, South Africa
  • T Ramabele Faculty of Health Sciences, University of Cape Town, South Africa
  • A Budge Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, South Africa
  • T Tarwa Molecular Mycobacteriology Research Unit, Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa
  • O Jim Faculty of Health Sciences, University of Cape Town, South Africa
  • T Maharaj Faculty of Health Sciences, University of Cape Town, South Africa
  • S Pandy Faculty of Health Sciences, University of Cape Town, South Africa
  • J-M Abrahams Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
  • A Panieri Faculty of Health Sciences, University of Cape Town, South Africa
  • S Verhage Faculty of Health Sciences, University of Cape Town, South Africa
  • M van der Merwe Faculty of Health Sciences, University of Cape Town, South Africa
  • A Geragotellis Faculty of Health Sciences, University of Cape Town, South Africa
  • W Amanjee Faculty of Health Sciences, University of Cape Town, South Africa
  • C Joseph Faculty of Health Sciences, University of Cape Town, South Africa
  • Z Zhao Faculty of Health Sciences, University of Cape Town, South Africa
  • S Moosa Faculty of Health Sciences, University of Cape Town, South Africa
  • M Bunting Faculty of Health Sciences, University of Cape Town, South Africa
  • Y Pulani Faculty of Health Sciences, University of Cape Town, South Africa
  • P Mukhari Faculty of Health Sciences, University of Cape Town, South Africa
  • M de Paiva Faculty of Health Sciences, University of Cape Town, South Africa
  • G Deyi Faculty of Health Sciences, University of Cape Town, South Africa
  • R P Wonkam Faculty of Health Sciences, University of Cape Town, South Africa
  • N Mancotywa Faculty of Health Sciences, University of Cape Town, South Africa
  • A Dunge Faculty of Health Sciences, University of Cape Town, South Africa
  • T Msimanga Faculty of Health Sciences, University of Cape Town, South Africa
  • A Singh Faculty of Health Sciences, University of Cape Town, South Africa
  • O Monnaruri Faculty of Health Sciences, University of Cape Town, South Africa
  • B Molale Faculty of Health Sciences, University of Cape Town, South Africa
  • T A G Butler Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, South Africa
  • K Browde Division of Allergology and Clinical Immunology, Department of Paediatrics, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
  • C Muller Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
  • J van der Walt Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
  • R Whitelaw Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • D Cronwright Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • S Sinha Faculty of Health Sciences, University of Cape Town, South Africa
  • U Binase Faculty of Health Sciences, University of Cape Town, South Africa
  • I Francis Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • D Boakye Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • S Dlamini Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • M Mendelson Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • J Peter Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2023.v113i2.16760

Keywords:

Public health, antibiotic

Abstract

Background. Up to a quarter of inpatients in high-income countries (HICs) self-report beta-lactam allergy (BLA), which if incorrect,
increases the use of alternative antibiotics, worsening individual health outcomes and driving bacterial resistance. In HICs, up to 95% of
self-reported BLAs are incorrect. The epidemiology of BLA in low- and middle-income African countries is unknown.
Objectives. To describe the epidemiology and de-labelling outcomes of self-reported BLA in hospitalised South African (SA) patients.
Methods. Point-prevalence surveys were conducted at seven hospitals (adult, paediatric, government and privately funded, district and
tertiary level) in Cape Town, SA, between April 2019 and June 2021. Ward prescription records and in-person interviews were conducted
to identify and risk-stratify BLA patients using the validated PEN-FAST tool. De-labelling was attempted at the tertiary allergy clinic at
Groote Schuur Hospital.
Results. A total of 1 486 hospital inpatients were surveyed (1 166 adults and 320 children). Only 48 patients (3.2%) self-reported a BLA,
with a higher rate in private than in government-funded hospitals (6.3% v. 2.8%; p=0.014). Using the PEN-FAST tool, only 10.4% (n=5/48)
of self-reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (n=34/48)
of self-reported BLA patients, with 64.7% (n=22/34) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling at
the allergy clinic, only 3/36 underwent in vivo testing, with no positive results, and 1 patient proceeded to a negative oral challenge.
Conclusion. Unlike HICs, self-reported BLA is low among inpatients in SA. The majority of those who self-reported BLA were low risk for
type 1 hypersensitivity, but outpatient de-labelling efforts were largely unsuccessful.

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Published

2023-02-01

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Research

How to Cite

1.
Day C, Deetlefs M, O’Brien A, Smith J, Boyd M, Embling N, et al. Self-reported beta-lactam allergy in government and private hospitals in Cape Town, South Africa. S Afr Med J [Internet]. 2023 Feb. 1 [cited 2024 Jul. 14];113(2):69-74. Available from: https://samajournals.co.za/index.php/samj/article/view/735

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