Methods
We conducted a multicenter point prevalence survey of hospitalised
patients. Between 4th of April 2019 and
14th of June 2021, a total of 1486 hospital inpatients
were surveyed at five government-funded hospitals and two
privately-funded hospitals in Cape Town South Africa. The
government-funded hospitals included Groote Schuur Hospital (GSH,
tertiary level), Red Cross Memorial Children’s Hospital (RXH, paediatric
tertiary level), and three secondary level Hospitals - Victoria Wynberg
Hospital (VWH), New Somerset Hospital (NSH), and Mitchells Plain
Hospital. The two privately-funded hospitals were Christiaan Barnard
Memorial Hospital (CBH) and University of Cape Town Academic Hospital
(UCTPAH) (Figure 1, Table 1, see Appendix for descriptions of
hospitals) .
This study was approved by the Human Ethics Research Counsel of the
University of Cape Town (UCT) (HREC: 417/2019) and the Netcare Research
Operations Committee. The delay in conducting the final surveys was due
to the COVID-19 pandemic, as six of the surveys were performed in
between the second and third COVID-19 waves in South Africa.
Point prevalence surveys were conducted after-hours to ensure that all
inpatient prescription chart were available for review. All hospital
inpatients on the day of the survey had basic demographic information
(date of birth and gender) captured via electronic case record form
(eCRF) but detailed medical information was only captured for patients
who reported a BLA or non-beta-lactam (BL) antibiotic allergy. Medical
information included documentation of antibiotic allergies in the
patients notes and prescription charts, description of the allergic
event, and review of information on the antibiotic prescription chart.
Classification of patients with a self-reported BLA was completed by an
allergist after completion of all surveys using the PEN-FAST tool. The
PEN-FAST BLA phenotype clinical decision tool (developed by Trubiano et
al(15)) has a high negative predictive value of 96.3% (95% CI
94.1-97.8%) (15, 17). The major criteria for the PEN-FAST tool are: the
allergy event occurring within the preceding five years (2 points);
anaphylaxis, angioedema or severe cutaneous delayed reactions (2
points). A single minor criterion of whether the allergic reaction
required treatment scores 1 point. The PEN-FAST tool has a validated
area under the curve of 0.805 (for a cut-off of 3 points chosen to
classify as low risk of penicillin allergy) (15). The novel PEN-FAST BLA
clinical decision mobile app was used by investigators to classify
patients as low risk (1-5%), moderate risk (20%), or high risk (50%)
of a positive penicillin allergy test.
Descriptive statistics were performed using counts and proportions for
categorical data, and medians and interquartile ranges for continuous
variables. All statistical analyses were conducted using STATA version
14 (STATA Corp., College Station, TX, USA).