Reply to Ressner et al.

care use and serious infection prevalence associated with penicillin " allergy " in hospitalized patients: a cohort study.ation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. The impact of penicillin skin testing on clinical practice and anti-microbial stewardship. Shenoy ES, et al. Improving clinical outcomes in patients with methicillin-sensitive Staphylococcus aureus bacteremia and reported penicillin allergy. TO THE EDITOR—We appreciate the comments of Ressner et al [1] regarding our invited article [2]. We agree that to be effective , efficient, as well as safe for patient care, antimicrobial stewardship programs need to be truly multidisciplinary and to have clear and accurate communication among the participants. A label of " penicillin allergy, " even when incorrect, limits antimicrobial de-escalation options and shifts antibiotic selection toward broader and more multidrug-resistant organisms-selective classes of antimicrobials [3]. Staff nurses interact with the drug allergy and antibiotic selection process at several points. First, they often take the admission medication allergy history for the in-patient record. Second, they review the antibiotic order for safety before actually administering the medication to the Figure 1. Flow chart of the approach taken at our institution to identify, rapidly assess, definitively evaluate, and properly categorize inpatients with a documented or reported allergy to penicillin or β-lactam allergy. This information is made available to the inpatient team and antimicrobial stewardship program during the current or future hospitalization, depending on the timing of evaluation.