Optimizing preoperative prophylaxis in patients with reported β-lactam allergy: a novel extension of antimicrobial stewardship
| Autor: | Jeff Powis, Sandy Hicks, Janine McCready, Alon Vaisman |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Microbiology (medical) Canada medicine.medical_specialty Pharmacist Cefazolin Pharmacists beta-Lactams Drug Hypersensitivity Antimicrobial Stewardship 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Antimicrobial stewardship Medicine Pharmacology (medical) Prospective Studies 030212 general & internal medicine Antibiotic prophylaxis Medical History Taking Adverse effect Intensive care medicine Aged Skin Tests Pharmacology Surgical team business.industry Perioperative Antibiotic Prophylaxis Middle Aged Anti-Bacterial Agents Infectious Diseases 030228 respiratory system Female Elective Surgical Procedure business medicine.drug |
| Zdroj: | Journal of Antimicrobial Chemotherapy. 72:2657-2660 |
| ISSN: | 1460-2091 0305-7453 |
| DOI: | 10.1093/jac/dkx171 |
| Popis: | Background Use of alternative second-line antibiotics is associated with adverse events in patients reporting β-lactam allergy. In the perioperative setting, we hypothesized that structured allergy histories, without the use of skin testing, can reduce alternative prophylactic antibiotic use. Objectives Assess the impact of structured allergy histories on patients with self-reported β-lactam allergy (SRBA) undergoing elective surgical procedures. Methods Structured allergy histories were performed by a pharmacist and reviewed with an infectious diseases physician. Patients were deemed safe to proceed with cefazolin prophylaxis if they did not describe a history of type I-mediated or severe reaction. Antibiotic prophylaxis orders (with approval by the surgical team) were scheduled into the computerized order entry system to be given prior to first incision of the operation. Results Of the 485 patients with SRBA that underwent structured allergy histories, 117 (24.1%) reported a type I-mediated allergy history; 267 (55.1%) patients received cefazolin prophylaxis and none subsequently experienced an adverse reaction. After intervention implementation, the overall use of alternative antibiotic prophylaxis at Michael Garron Hospital (Toronto, Canada) among those with SRBA decreased from 81.9% to 55.9%. This drop was associated with the number of monthly assessments (P |
| Databáze: | OpenAIRE |
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