Use of a beta-lactam graded challenge process for inpatients with self-reported penicillin allergies at an academic medical center.
| Autor: | Sunagawa SW; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, United States., Bergman SJ; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, United States.; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States., Kreikemeier E; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, United States., Watkins AB; Department of Pharmacy, St. Dominic Jackson Memorial Hospital, Jackson, MS, United States., Alexander BT; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, United States., Miller MM; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, United States., Schroeder D; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, United States., Stohs EJ; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States., Van Schooneveld TC; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States., May SM; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States. |
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| Jazyk: | angličtina |
| Zdroj: | Frontiers in allergy [Front Allergy] 2023 Jul 31; Vol. 4, pp. 1161683. Date of Electronic Publication: 2023 Jul 31 (Print Publication: 2023). |
| DOI: | 10.3389/falgy.2023.1161683 |
| Abstrakt: | Background: The Antimicrobial Stewardship Program (ASP) at Nebraska Medicine collaborated with a board-certified allergist to develop a penicillin allergy guidance document for treating inpatients with self-reported allergy. This guidance contains an algorithm for evaluating and safely challenging penicillin-allergic patients with beta-lactams without inpatient allergy consults being available. Methods: Following multi-disciplinary review, an order set for beta-lactam graded challenges (GC) was implemented in 2018. This contains recommended monitoring and detailed medication orders to challenge patients with various beta-lactam agents. Inpatient orders for GC from 3/2018-6/2022 were retrospectively reviewed to evaluate ordering characteristics, outcomes of the challenge, and whether documentation of the allergy history was updated. All beta-lactam challenges administered to inpatients were included, and descriptive statistics were performed. Results: Overall, 157 GC were administered; 13 with oral amoxicillin and 144 with intravenous (IV) beta-lactams. Ceftriaxone accounted for the most challenges (43%). All oral challenges were recommended by an Infectious Diseases consult service, as were a majority of IV challenges (60%). Less than one in five were administered in an ICU (19%). Almost all ( n = 150, 96%) were tolerated without any adverse event. There was one reaction (1%) of hives and six (4%) involving a rash, none of which had persistent effects. Allergy information was updated in the electronic health record after 92% of the challenges. Conclusion: Both intravenous and oral beta-lactam graded challenges were implemented successfully in a hospital without a regular inpatient allergy consult service. They were well-tolerated, administered primarily in non-ICU settings, and were often ordered by non-specialist services. In patients with a self-reported penicillin allergy, these results demonstrate the utility and safety of a broadly adopted beta-lactam GC process. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Sunagawa, Bergman, Kreikemeier, Watkins, Alexander, Miller, Schroeder, Stohs, Van Schooneveld and May.) |
| Databáze: | MEDLINE |
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