Impact of a Pharmacist-Conducted Preoperative Beta-Lactam Allergy Assessment on Perioperative Cefazolin Prescribing.

Autor:	Hitchcock AM; Department of Pharmacy, State University of New York Upstate University Hospital, Syracuse, NY, USA.; Department of Pharmacy, University of Pittsburgh Medical Center Harrisburg, Harrisburg, PA, USA., Kufel WD; Department of Pharmacy, State University of New York Upstate University Hospital, Syracuse, NY, USA.; Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA.; Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA., Seabury RW; Department of Pharmacy, State University of New York Upstate University Hospital, Syracuse, NY, USA.; Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA., Steele JM; Department of Pharmacy, State University of New York Upstate University Hospital, Syracuse, NY, USA.; Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.
Jazyk:	angličtina
Zdroj:	Journal of pharmacy practice [J Pharm Pract] 2024 Oct; Vol. 37 (5), pp. 1073-1081. Date of Electronic Publication: 2023 Nov 06.
DOI:	10.1177/08971900231214581
Abstrakt:	Background: Cefazolin is guideline recommended for perioperative prophylaxis in orthopedic surgery. Despite its unique R1 side chain, cefazolin is often avoided in patients with beta-lactam allergy with concern for cross reactivity. Objectives: The primary outcome was the percentage of patients who received cefazolin perioperatively. Secondary outcomes included the percentage of patients with a beta-lactam allergy clarified following the telephone interview and clinical outcomes including acute kidney injury, surgical site infection, Clostridioides difficile infection, and re-admission at 30 and 90 days. Methods: This single-center, quasi-experimental study evaluated a pilot program in which a pharmacist phoned patients > 18 years of age with a scheduled orthopedic surgery and a documented beta-lactam allergy to assess their allergy preoperatively. Recommendations to use cefazolin were based on an algorithm. Patients were divided into pre- and post-intervention cohorts. Results: A total of 832 patients were screened for inclusion with 135 and 66 patients included in the pre- and post-intervention cohorts. No significant difference was identified in the primary outcome. In the post-intervention cohort, 62% had a beta-lactam reaction updated in the electronic medical record. Those with a beta-lactam allergy delabeled or made less severe were numerically more likely to receive cefazolin than those with an unchanged reaction or a reaction made more severe (95.2% vs 68% vs 65%). There were no differences in clinical outcomes between groups. Conclusion: A pharmacist-conducted preoperative beta-lactam allergy interview in adult patients undergoing elective orthopedic surgery improved beta-lactam allergy documentation but, did not result in increased utilization of cefazolin. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Wesley D. Kufel has received research grants from Merck and Co. and Melinta Therapeutics and served on the advisory board for Theratechnologies. Jeffrey M. Steele has served on the advisory board for Paratek Pharmaceuticals. All other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu