Outcomes from an inpatient beta-lactam allergy guideline across a large US health system
| Autor: | David N. Berkowitz, Victoria Carballo, Ronak G Gandhi, Erica S. Shenoy, Yu Li, Kimberly G. Blumenthal, Monique Freeley, Paige G. Wickner, Ramy H. Elshaboury, Barbara B. Lambl, Kathleen A. Marquis, Jesse M. Schwartz, Alana Gruszecki, Joyce T. Hsu, Anna R. Wolfson |
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| Rok vydání: | 2019 |
| Předmět: |
Microbiology (medical)
Adult Male medicine.medical_specialty Allergy Drug-Related Side Effects and Adverse Reactions Epidemiology Penicillins Logistic regression beta-Lactams Drug Hypersensitivity 03 medical and health sciences Antimicrobial Stewardship Young Adult 0302 clinical medicine Internal medicine medicine Antimicrobial stewardship Humans 030212 general & internal medicine Young adult Aged Retrospective Studies Inpatients business.industry Retrospective cohort study Odds ratio Guideline Middle Aged medicine.disease Decision Support Systems Clinical Confidence interval United States 3. Good health Anti-Bacterial Agents Cephalosporins Infectious Diseases 030228 respiratory system Practice Guidelines as Topic Female Original Article business |
| Zdroj: | Infection Control and Hospital Epidemiology |
| ISSN: | 1559-6834 0899-823X |
| Popis: | Objective:To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported β-lactam allergies.Design:Retrospective cohort study.Setting:Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.Methods:We evaluated β-lactam antibiotic test-dose outcomes, including adverse drug reactions (ADRs), hypersensitivity reactions (HSRs), and electronic health record (EHR) allergy record updates. HSR predictors were examined using a multivariable logistic regression model. Modification of the EHR allergy record after test doses considered relevant allergy entries added, deleted, and/or specified.Results:We identified 1,046 test-doses: 809 (77%) to cephalosporins, 148 (14%) to penicillins, and 89 (9%) to carbapenems. Overall, 78 patients (7.5%; 95% confidence interval [CI], 5.9%–9.2%) had signs or symptoms of an ADR, and 40 (3.8%; 95% CI, 2.8%–5.2%) had confirmed HSRs. Most HSRs occurred at the second (ie, full-dose) step (68%) and required no treatment beyond drug discontinuation (58%); 3 HSR patients were treated with intramuscular epinephrine. Reported cephalosporin allergy history was associated with an increased odds of HSR (odds ratio [OR], 2.96; 95% CI, 1.34–6.58). Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).Conclusion:This antimicrobial stewardship intervention using β-lactam test-dose procedures was safe. Overall, 3.8% of patients with β-lactam allergy histories had an HSR; cephalosporin allergy histories conferred a 3-fold increased risk. Encouraging EHR documentation might improve this safe, effective, and practical acute-care antibiotic stewardship tool. |
| Databáze: | OpenAIRE |
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