Analysis of a beta-lactam allergy assessment protocol challenging diverse reported allergies managed by an antimicrobial stewardship program.

Autor:	Jacobs MW; Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA., Bremmer DN; Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA., Shively NR; Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USA., Moffa MA; Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USA., Trienski TL; Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA., Carr DR; Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA., Buchanan CA; Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA., Walsh TL; Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USA.
Jazyk:	angličtina
Zdroj:	Antimicrobial stewardship & healthcare epidemiology : ASHE [Antimicrob Steward Healthc Epidemiol] 2023 Sep 08; Vol. 3 (1), pp. e153. Date of Electronic Publication: 2023 Sep 08 (Print Publication: 2023).
DOI:	10.1017/ash.2023.432
Abstrakt:	Objective: To assess the safety and efficacy of a novel beta-lactam allergy assessment algorithm managed by an antimicrobial stewardship program (ASP) team. Design: Retrospective analysis. Setting: One quaternary referral teaching hospital and one tertiary care teaching hospital in a large western Pennsylvania health network. Patients or Participants: Patients who received a beta-lactam challenge dose under the beta-lactam allergy assessment algorithm. Interventions: A beta-lactam allergy assessment protocol was designed and implemented by an ASP team. The protocol risk stratified patients' reported allergies to identify patients appropriate for a challenge with a beta-lactam antibiotic. This retrospective analysis assessed the safety and efficacy of this protocol among patients receiving a challenge dose from November 2017 to July 2021. Results: Over a 45-month period, 119 total patients with either penicillin or cephalosporin allergies entered the protocol. Following a challenge dose, 106 (89.1%) patients were treated with a beta-lactam. Eleven patients had adverse reactions to a challenge dose, one of which required escalation of care to the intensive care unit. Of the patients with an unknown or low-risk reported allergy, 7/66 (10.6%) had an observed adverse reaction compared to 3/42 (7.1%) who had an observed reaction with a reported high-risk or anaphylactic allergy. Conclusions: Our implemented protocol was safe and effective, with over 90% of patients tolerating the challenge without incident and many going on to receive indicated beta-lactam therapy. This protocol may serve as a framework for other inpatient ASP teams to implement a low-barrier allergy assessment led by ASP teams. Competing Interests: D.C. discloses a relationship with Merck—Speaker’s Bureau. D.B. discloses a relationship with Thermo Fisher Scientific—Speaker’s Bureau. No other authors have potential conflicts of interest. There are no publicly available data sets that are being shared as a result of this analysis. These data and findings have not been previously reported. (© The Author(s) 2023.)
Databáze:	MEDLINE
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