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Peer-reviewedCC BY 4.0Infection

Penicillin allergy delabeling in a German University Hospital—implementation in inpatient settings: the PenGuin Pilot Study

  • Hannah Nürnberg1,2
  • Katrin Hörth1
  • Kristin Egenberger1
  • Stefanie Amelung1
  • Elena Jaszkowski1
  • Julia Bauer1
  • Carolin Deiß1
  • Ute Chiriac1
  • Alexandra Weber1
  • Anne Wiesner1
  • Britta Kölking2
  • David Martin2
5 more authors
  • Miriam Pasinato2
  • Tilman Schöning1
  • Claudia M. Denkinger2,3
  • Benedict Morath1
  • Elham Khatamzas2,3
  1. 1Hospital Pharmacy, University Hospital Heidelberg, Heidelberg, Germany
  2. 2Department of Infectious Diseases and Tropical Medicine, University Hospital Heidelberg, Heidelberg, Germany
  3. 3German Center of Infection Research, Partner site Heidelberg, Braunschweig, Germany
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Abstract

Background: Penicillin allergy (PenA) is reported in up to 15% of hospitalized patients, although true IgE-mediated hypersensitivity is rare. PenA delabeling is an important antimicrobial stewardship intervention, as mislabeling is associated with adverse clinical outcomes. While structured delabeling interventions are safe and effective, their translation into routine care across different healthcare settings remains unclear.

Methods: This prospective implementation study was conducted on four wards of a 2600-bed German tertiary care center. All adult inpatients with reported PenA underwent structured allergy assessment and risk stratification by clinical pharmacists. Low risk patients were delabeled directly, while moderate-risk patients were evaluated for direct oral challenge (DOC). Outcomes included delabeling rate at discharge, ward-specific differences, and implementation barriers and facilitators assessed by staff questionnaires. Sustainability was evaluated by primary care follow-up 32 weeks after discharge.

Results: Among 2890 screened patients, 179 (6.2%) reported a PenA. Of 162 eligible patients, 54 (33.3%) were successfully delabeled. DOC was well tolerated, with only one mild skin reaction observed. Ward-specific environments influenced the use of different delabeling strategies. Key barriers included staffing shortages, short hospital stays, and patient-related factors, whereas facilitators included easy integration into pharmacist workflows and interprofessional collaboration. Follow-up showed limited transfer of delabeling outcomes to primary care, reducing long-term sustainability.

Conclusion: Pharmacist-led PenA delabeling can be safely integrated and is feasible within existing clinical workflows. However, real-world implementation barriers and incomplete transfer to primary care limited its full potential. Improve standardized documentation and cross-sector communication are important for sustainable and widespread implementation of delabeling strategies.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02915-7.

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Cite

BibTeXRIS
BibTeX
@article{nurnberg2026penicillin,
  title = {{Penicillin allergy delabeling in a German University Hospital—implementation in inpatient settings: the PenGuin Pilot Study}},
  author = {Hannah Nürnberg and Katrin Hörth and Kristin Egenberger and Stefanie Amelung and Elena Jaszkowski and Julia Bauer and Carolin Deiß and Ute Chiriac and Alexandra Weber and Anne Wiesner and Britta Kölking and David Martin and Miriam Pasinato and Tilman Schöning and Claudia M. Denkinger and Benedict Morath and Elham Khatamzas},
  journal = {Infection},
  year = {2026},
  month = aug,
  doi = {10.1007/s15010-026-02915-7},
  url = {https://doi.org/10.1007/s15010-026-02915-7},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Penicillin allergy delabeling in a German University Hospital—implementation in inpatient settings: the PenGuin Pilot Study
AU  - Hannah Nürnberg
AU  - Katrin Hörth
AU  - Kristin Egenberger
AU  - Stefanie Amelung
AU  - Elena Jaszkowski
AU  - Julia Bauer
AU  - Carolin Deiß
AU  - Ute Chiriac
AU  - Alexandra Weber
AU  - Anne Wiesner
AU  - Britta Kölking
AU  - David Martin
AU  - Miriam Pasinato
AU  - Tilman Schöning
AU  - Claudia M. Denkinger
AU  - Benedict Morath
AU  - Elham Khatamzas
PY  - 2026
DA  - 2026/08/11
JO  - Infection
DO  - 10.1007/s15010-026-02915-7
UR  - https://doi.org/10.1007/s15010-026-02915-7
AB  - Background: Penicillin allergy (PenA) is reported in up to 15% of hospitalized patients, although true IgE-mediated hypersensitivity is rare. PenA delabeling is an important antimicrobial stewardship intervention, as mislabeling is associated with adverse clinical outcomes. While structured delabeling interventions are safe and effective, their translation into routine care across different healthcare settings remains unclear.  Methods: This prospective implementation study was conducted on four wards of a 2600-bed German tertiary care center. All adult inpatients with reported PenA underwent structured allergy assessment and risk stratification by clinical pharmacists. Low risk patients were delabeled directly, while moderate-risk patients were evaluated for direct oral challenge (DOC). Outcomes included delabeling rate at discharge, ward-specific differences, and implementation barriers and facilitators assessed by staff questionnaires. Sustainability was evaluated by primary care follow-up 32 weeks after discharge.  Results: Among 2890 screened patients, 179 (6.2%) reported a PenA. Of 162 eligible patients, 54 (33.3%) were successfully delabeled. DOC was well tolerated, with only one mild skin reaction observed. Ward-specific environments influenced the use of different delabeling strategies. Key barriers included staffing shortages, short hospital stays, and patient-related factors, whereas facilitators included easy integration into pharmacist workflows and interprofessional collaboration. Follow-up showed limited transfer of delabeling outcomes to primary care, reducing long-term sustainability.  Conclusion: Pharmacist-led PenA delabeling can be safely integrated and is feasible within existing clinical workflows. However, real-world implementation barriers and incomplete transfer to primary care limited its full potential. Improve standardized documentation and cross-sector communication are important for sustainable and widespread implementation of delabeling strategies.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02915-7.
SN  - 0300-8126
SN  - 1439-0973
ER  -