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Self-reported beta-lactam allergy: inpatients in government funded and privately funded hospitals Cape Town, South Africa
  • +46
  • Cascia Day,
  • M. Deetlefs,
  • A. O’Brien,
  • J. Smith,
  • M. Boyd,
  • N. Embling,
  • S. Patel,
  • K. Moody,
  • T. Ramabele,
  • A. Budge,
  • Tapiwa Tavarwisa Tarwa,
  • O. Jim,
  • T. Maharaj,
  • S. Pandy,
  • JM. Abrahams,
  • A. Panieri,
  • S. Verhage,
  • M. van der Merwe,
  • A. Geragotellis,
  • W. Amanjee,
  • C. Joseph,
  • Z. Zhao,
  • S. Moosa,
  • M. Bunting,
  • Yanelisa Pulani,
  • P. Mukhari,
  • M. de Paiva,
  • G. Deyi,
  • R. Peigou Wonkam,
  • N. Mancotywa,
  • A. Dunge,
  • T. Msimanga,
  • A. Singh,
  • O. Monnaruri,
  • B. Molale,
  • T. Butler,
  • K. Browde,
  • C. Muller,
  • J. Van Der Walt,
  • R. Whitelaw,
  • D. Cronwright,
  • N. Parker,
  • S. Sinha,
  • U. Binase,
  • I. Francis,
  • D. Boakye,
  • S. Dlamini,
  • M. Mendelson,
  • Jonny PETER
Cascia Day
University of Cape Town Division of Immunology

Corresponding Author:cascia.day@uct.ac.za

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M. Deetlefs
University of Cape Town Division of Immunology
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A. O’Brien
University of Cape Town Faculty of Health Sciences
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J. Smith
University of Cape Town Faculty of Health Sciences
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M. Boyd
University of Cape Town Institute of Infectious Disease and Molecular Medicine
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N. Embling
University of Cape Town Faculty of Health Sciences
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S. Patel
University of Cape Town Faculty of Health Sciences
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K. Moody
University of Cape Town Faculty of Health Sciences
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T. Ramabele
University of Cape Town Faculty of Health Sciences
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A. Budge
University of Cape Town Department of Paediatrics and Child Health
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Tapiwa Tavarwisa Tarwa
University of Cape Town Department of Pathology
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O. Jim
University of Cape Town Faculty of Health Sciences
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T. Maharaj
University of Cape Town Faculty of Health Sciences
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S. Pandy
University of Cape Town Faculty of Health Sciences
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JM. Abrahams
University of Cape Town Division of Immunology
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A. Panieri
University of Cape Town Faculty of Health Sciences
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S. Verhage
University of Cape Town Faculty of Health Sciences
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M. van der Merwe
University of Cape Town Faculty of Health Sciences
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A. Geragotellis
University of Cape Town Faculty of Health Sciences
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W. Amanjee
University of Cape Town Faculty of Health Sciences
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C. Joseph
University of Cape Town Faculty of Health Sciences
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Z. Zhao
University of Cape Town Faculty of Health Sciences
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S. Moosa
University of Cape Town Faculty of Health Sciences
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M. Bunting
University of Cape Town Faculty of Health Sciences
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Yanelisa Pulani
University of Cape Town Faculty of Health Sciences
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P. Mukhari
University of Cape Town Faculty of Health Sciences
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M. de Paiva
University of Cape Town Faculty of Health Sciences
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G. Deyi
University of Cape Town Faculty of Health Sciences
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R. Peigou Wonkam
University of Cape Town Faculty of Health Sciences
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N. Mancotywa
University of Cape Town Faculty of Health Sciences
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A. Dunge
University of Cape Town Faculty of Health Sciences
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T. Msimanga
University of Cape Town Faculty of Health Sciences
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A. Singh
University of Cape Town Faculty of Health Sciences
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O. Monnaruri
University of Cape Town Faculty of Health Sciences
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B. Molale
University of Cape Town Faculty of Health Sciences
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T. Butler
University of Cape Town Department of Paediatrics and Child Health
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K. Browde
University of Cape Town Division of Immunology
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C. Muller
University of Cape Town Lung Institute
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J. Van Der Walt
University of Cape Town Division of Immunology
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R. Whitelaw
University of Cape Town Faculty of Health Sciences
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D. Cronwright
University of Cape Town Faculty of Health Sciences
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N. Parker
University of Cape Town Faculty of Health Sciences
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S. Sinha
University of Cape Town Faculty of Health Sciences
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U. Binase
University of Cape Town Faculty of Health Sciences
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I. Francis
University of Cape Town Faculty of Health Sciences
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D. Boakye
University of Cape Town Faculty of Health Sciences
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S. Dlamini
University of Cape Town Institute of Infectious Disease and Molecular Medicine
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M. Mendelson
University of Cape Town Institute of Infectious Disease and Molecular Medicine
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Jonny PETER
University of Cape Town Division of Immunology
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Abstract

Background Up to a quarter of inpatients in high-income countries self-report beta-lactam allergy (BLA), which if incorrect, can increase use of alternative antibiotics that impact on bacterial resistance.. The epidemiology of BLA in low- and middle-income African countries is unknown. Methods Point-prevalence surveys were conducted at seven hospitals (adult, pediatric, government and private-funded, district- and tertiary-level) in Cape Town, South Africa between April 2019 and June 2021. Ward prescription records and interviews were conducted to identify BLA patients. De-labeling was attempted at the tertiary allergy clinic at Groote Schuur hospital. Findings A total of 1486 hospital inpatients were surveyed (1166 adults; 308 children). Only 48 (3.2%) patients self-reported a BLA with a higher rate amongst private- versus government-funded hospitals [6.3% vs 2.8%, p=0.014]. Using the PEN-FAST tool, only 10.4% (5/48) of self reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (34/48) of self reported BLA patients, with 64.7% (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 one patient proceeded toa negative oral challenge. Interpretation Unlike high-income countries, self-reported BLA is low amongst inpatients in South Africa. The majority of self-reported BLA were low risk for type 1 hypersensitivity, but out-patient de-labeling efforts were largely unsuccessful. Funding None