Introduction: A documented penicillin allergy is associated with increased morbidity and mortality, and critically ill patients are particularly vulnerable to the consequences of suboptimal antibiotic therapy. Reported allergies are often inaccurate, outdated, or low risk. Pharmacists are well positioned to evaluate penicillin allergies as part of antimicrobial stewardship initiatives. This study sought to evaluate a pharmacy driven penicillin allergy assessment in a surgical intensive care unit (ICU). Methods: A retrospective cohort study was performed to evaluate pharmacist interventions among patients with listed penicillin allergies in the surgical intensive care unit. The primary outcome was the percentage of patients with characterized pharmacist interventions. The secondary outcome was the percentage of patients who received either a penicillin or cephalosporin after a pharmacist review. Results: A total of 148 patients were evaluated between September 2021 and July 2024. The most common surgical procedures included gastrointestinal, abdominal transplant, and orthopedic surgeries. Ninety-nine (67.8%) patients did not specify the penicillin agent in their allergy. The most common reaction listed was an IgE mediated reaction other than anaphylaxis such as hives or rash (n= 33, 22.4%), and only 12 patients (8.2%) had listed anaphylaxis. Upon chart review or patient interview, pharmacists found that 134 patients (90.5%) had previously tolerated a beta-lactam, which was added to the allergy comments. Other pharmacist interventions included modification of severity of reaction (n=25, 16.9%), modification of reaction type (n=23, 15.5%), and recommendation of allergy testing (n= 11, 7.4%). After pharmacist review, 104 (70.3%) of patients received either a penicillin or a cephalosporin during their hospitalization, and of those who survived, 56 (41.2%) had a documented outpatient penicillin or cephalosporin prescription within 2 years of admission. Conclusions: Pharmacist-led penicillin allergy assessments in the surgical ICU significantly contributed to improved allergy documentation and increased use of beta-lactam antibiotics. These findings highlight the critical role of pharmacists in clarifying allergies and optimizing antibiotic selection in the ICU.
Marchionda et al. (Sun,) studied this question.