ObjectivesPrudent handling of reported antibiotic allergies is an important aspect of antibiotic stewardship. The Dutch Working Party on Antibiotic Policy (SWAB) constituted a multidisciplinary... Show moreObjectivesPrudent handling of reported antibiotic allergies is an important aspect of antibiotic stewardship. The Dutch Working Party on Antibiotic Policy (SWAB) constituted a multidisciplinary expert committee to provide evidence-based recommendations for bedside decision-making in antibiotic therapy in patients that report an antibiotic allergy.MethodsThe guideline committee generated 12 key questions, most of which were population, intervention, comparison, and outcome questions relevant to both children and adults with suspected antibiotic allergies. For each question, a systematic literature search was performed and reviewed for the best available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The quality of evidence was graded from very low to high, and recommendations were formulated in structured discussions as strong or weak.ResultsSixty recommendations were provided for suspected allergy to β-lactam antibiotics (BLAs) and non–β-lactam antibiotics. Owing to the absence of randomized controlled trials in this field, the underlying evidence was predominantly graded as low or very low. Available data support that a detailed allergy history should always be performed and critically appraised. When cross-allergy between BLA groups is not to be expected due to the absence of molecular similarity of the side chains, the patient can be safely exposed to the alternative BLA. An exception to this rule is severe delayed-type reactions in which re-exposure to a BLA should only be considered after consultation with a multidisciplinary team.ConclusionsAccumulated scientific data now support a more liberal approach that better balances the benefits of treatment with first choice and usually smaller spectrum antibiotics with appropriate avoidance of antibiotics in case of a truly high risk of a (severe) allergic reaction. In The Netherlands, a formal guideline was developed that provides recommendations for the approach toward suspected allergy to BLA and frequently used non–β-lactam antibiotics, thereby strongly supporting antimicrobial stewardship. Show less
Our study aim is to determine how a new clinical pathway, including PCR-based influenza point-ofcare test (POCT), influences the hospitalisation costs of patients suspected of influenza presenting... Show moreOur study aim is to determine how a new clinical pathway, including PCR-based influenza point-ofcare test (POCT), influences the hospitalisation costs of patients suspected of influenza presenting at the emergency department of a Dutch hospital during two consecutive influenza epidemics (2016- 2017 and 2017-2018). Compared to mean costs per patient of €3,661 in 2016-2017, the implementation of this new clinical pathway with influenza POCT in 2017 was associated with mean costs per influenza-positive patient of €2,495 in 2017-2018 (p=0.3). Our study suggests favourable economic results regarding a new clinical pathway with influenza POCT, reflecting a more efficient care of patients suspected of influenza presenting at the emergency department. Show less
Reusken, C.B.; Buiting, A.; Bleeker-Rovers, C.; Diederen, B.; Hooiveld, M.; Friesema, I.; ... ; Kluytmans, J. 2020
To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with... Show moreTo rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active circulation) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within 2 days, 1,097 HCW in nine hospitals were tested; 45 (4.1%) were positive. Of six hospitals with positive HCW, two accounted for 38 positive HCW. The results informed local and national risk management. Show less
