Norwegian Anaesthesiologist's Perspectives on Perioperative Allergies and Penicillin Allergy Evaluations: A National Survey.

backgroundPenicillin allergy is a frequent challenge in perioperative antibiotic stewardship. Although 3%-10% of hospitalised patients declare a penicillin allergy, up to 95% of penicillin allergy labels are refuted through allergologic testing. Identifying incorrect penicillin allergy labels reduces the consumption of broad-spectrum second-line antibiotics, benefiting patients and society. Penicillin allergy evaluation is a recommended action for fighting antimicrobial resistance, and the procedure is under-facilitated perioperatively. Anaesthesiologists are important stakeholders in perioperative antibiotic stewardship, but knowledge about their attitudes and potential barriers to adopting penicillin allergy evaluation is scarce.

methodsWe conducted a national, cross-sectional online survey among 1667 members of the Norwegian Anaesthesiology Association. The study was informed by the British Drug Allergy Labels in Elective Surgical Patients anaesthesiologist survey. The survey examined knowledge about perioperative allergies and penicillin allergy evaluations. Quantitative data were analysed descriptively, and qualitative data were analysed using systematic text condensation.

resultsWe received 405 responses (24% response rate). Barriers to penicillin allergy evaluation included: (1) a perceived lack of knowledge, (2) time constraints and the absence of structured workflows, and (3) not feeling responsible for evaluating penicillin allergies. If respondents believed that the declared penicillin allergy was highly unlikely to represent a true allergy, 65% would administer penicillin. However, in patients de-labelled by oral provocation testing with penicillin, 34% of the respondents would still not re-expose the patient to penicillins. Senior clinicians expressed the lowest confidence in evaluating penicillin allergies, and respondents were mostly unaware of national penicillin allergy evaluation guidelines. DISCUSSION: Distrust in penicillin allergy evaluation procedures is prevalent among Norwegian anaesthesiologists. Key barriers to the implementation of perioperative penicillin allergy evaluation include time constraints, insufficient knowledge and unclear clinical responsibilities. To improve commitment, targeted education, specialty-specific guidelines, a simplified drug allergy warning system, and clearly defined roles are essential. We compared our results with results from the UK and found similar challenges. As our findings reflect challenges reported in other European countries, we call for a coordinated European initiative to enhance the implementation of perioperative penicillin allergy evaluations. Increasing anaesthesiologists' engagement in penicillin allergy evaluation can potentially improve perioperative outcomes and reduce antimicrobial resistance. EDITORIAL COMMENT: This survey study assessed clinician opinions of penicillin allergy evaluation in one Scandinavian country. The authors present suggestions for improving the process for evaluation of suspected penicillin allergy as part of a general clinician responsibility for antibiotic treatment stewardship.