Impact of antibiotic allergy labels on timely and appropriate antibiotics for sepsis in the emergency department.

Autor:	Rush L; Pharmacy Department, Alfred Health, Melbourne, Australia., Rashidzada Z; Pharmacy Department, Alfred Health, Melbourne, Australia., Cairns K; Pharmacy Department, Alfred Health, Melbourne, Australia., Roman C; Pharmacy Department, Alfred Health, Melbourne, Australia.; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia., Bourne T; Emergency Department, Alfred Health, Melbourne, Australia., Orosz J; Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Australia., Poole S; Pharmacy Department, Alfred Health, Melbourne, Australia., Lee SJ; Department of Infectious Diseases, Alfred Health, Melbourne, Australia.; Central Clinical School, Monash University, Melbourne, Australia., Peel T; Department of Infectious Diseases, Alfred Health, Melbourne, Australia.; Department of Infectious Diseases, Monash University, Melbourne, Australia.
Jazyk:	angličtina
Zdroj:	JAC-antimicrobial resistance [JAC Antimicrob Resist] 2023 Dec 11; Vol. 5 (6), pp. dlad120. Date of Electronic Publication: 2023 Dec 11 (Print Publication: 2023).
DOI:	10.1093/jacamr/dlad120
Abstrakt:	Objectives: Time to initiation of effective antibiotic therapy is a strong predictor of survival for patients with sepsis presenting to the Emergency Department (ED). Antibiotic allergy labels (AALs) are a known barrier to timely sepsis management. The aim was to evaluate the influence of AALs on timely sepsis management for ED sepsis presentations in an Australian hospital. Methods: A retrospective cohort study was conducted for ED presentations requiring direct ICU admission for suspected sepsis, comparing patients with and without an AAL using propensity scores. Results: Between November 2018 and June 2021, 377 patients were included. The prevalence of an AAL was 29.6% (86/377). The median time to antibiotic administration was similar in the AAL versus non-AAL groups (51 versus 60 min, P  = 0.11); there was no difference in mortality (14.1% versus 14.0%, P  = 0.98) and length of stay (9.21 versus 10.10 days). The median time to antibiotic administration was shorter in those with Emergency Medicine (EM) pharmacist attendance versus those without (50 versus 92 min, P  = 0.0001). Appropriateness of antibiotic prescription was 91.0% (343/377) for the overall cohort and was not associated with AALs, possibly due to our clear antimicrobial sepsis guidelines; however, EM pharmacist involvement was associated with increased antibiotic appropriateness (97.3% versus 88.4%, P  = 0.00048). Conclusions: In our Australian ED, AALs were not found to impact timeliness of antibiotic administration in patients with sepsis. EM pharmacist involvement was associated with improved timeliness and appropriateness of antibiotic selection in patients presenting with sepsis. (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
Databáze:	MEDLINE
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