A novel 2-step process for the management of inpatient beta-lactam allergy labels.

Autor:	Ravikumar R; Division of Allergy and Clinical Immunology, Michigan Medicine, Ann Arbor, Michigan. Electronic address: rajanr@med.umich.edu., Arora NS; Department of Internal Medicine, University of North Carolina, Chapel Hill, North Carolina., Hanson R; Division of Allergy and Clinical Immunology, Michigan Medicine, Ann Arbor, Michigan., Barhitte L; Division of Allergy and Clinical Immunology, Michigan Medicine, Ann Arbor, Michigan., Nagel J; Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan., Aitken SL; Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan., Bashaw L; Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan., Gandhi T; Division of Infectious Diseases, Michigan Medicine, Ann Arbor, Michigan., Spranger E; Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan., Marshall VD; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan., Eschenauer GA; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan.
Jazyk:	angličtina
Zdroj:	Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology [Ann Allergy Asthma Immunol] 2024 Apr; Vol. 132 (4), pp. 525-531.e1. Date of Electronic Publication: 2023 Dec 25.
DOI:	10.1016/j.anai.2023.12.028
Abstrakt:	Background: Inpatient beta-lactam allergy labels may increase the unnecessary use of aztreonam and non-beta-lactam antibiotics, which can then lead to more adverse events and increased health care costs, OBJECTIVE: To assess the impact of a novel 2-step process (medication history review followed by risk stratification) on rates of beta-lactam delabeling, aztreonam use, and desensitizations on pediatric, adult, and obstetrics inpatients at a tertiary academic center. Methods: We prospectively collected data on 700 patients who received inpatient consultation from the Beta-Lactam Allergy Evaluation Service between August 2021 and July 2022. Patients were delabeled either by medication review alone, drug challenge alone if with a low-risk history, or penicillin skin test followed by drug challenge if with a high-risk history. Generalized linear regression modeling was used to compare aztreonam days of therapy in the intervention year with the 2 prior years. Drug desensitizations were assessed by electronic chart review. Results: Most of the patients (n = 656 of 700, 94%) had more than or equal to 1 beta-lactam allergy label removed, clarified, or both; 77.9% of these patients (n = 511 of 656) had 587 beta-lactam allergy labels removed. Nearly one-third (n = 149, 27.6%) had 162 allergy labels removed solely by medication history review. All 114 penicillin skin tests performed had negative results, and 98% (8 of 381) of the patients who underwent any drug challenge passed. Only 5.7% of the delabeled patients were relabeled. There was a 27% reduction in aztreonam use (P = .007). Beta-lactam desensitizations were reduced by 80%. Conclusion: A full-time inpatient beta-lactam allergy service using medication history review and risk stratification can safely and effectively remove inpatient beta-lactam allergy labels, reduce aztreonam use, and decrease beta-lactam desensitizations. (Copyright © 2024 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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