Impact of an antimicrobial stewardship initiative to evaluate β-lactam allergy in patients ordered aztreonam
| Autor: | Christopher A. Jankowski, Petra Aldridge, Jason Ferreira, Lori Dupree, Petra M. Estep |
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| Rok vydání: | 2016 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Pediatrics Allergy medicine.drug_class 030106 microbiology Antibiotics Aztreonam beta-Lactams Drug Hypersensitivity Random Allocation 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Anti-Infective Agents Internal medicine polycyclic compounds Humans Antimicrobial stewardship Medicine 030212 general & internal medicine Adverse effect Aged Retrospective Studies Pharmacology business.industry Health Policy Retrospective cohort study Middle Aged biochemical phenomena metabolism and nutrition medicine.disease Antimicrobial Anti-Bacterial Agents Discontinuation chemistry Female business |
| Zdroj: | American Journal of Health-System Pharmacy. 73:S8-S13 |
| ISSN: | 1535-2900 1079-2082 |
| DOI: | 10.2146/ajhp150440 |
| Popis: | Purpose An evaluation of the clinical and economic impact of an antimicrobial stewardship quality initiative (ASQI) focusing on allergy assessment in patients with a documented β-lactam allergy prescribed aztreonam was conducted. Methods This retrospective study was executed at a hospital with an interdisciplinary antimicrobial stewardship program (ASP). A total of 186 patients with self-reported β-lactam allergies who were prescribed aztreonam while admitted during a 36-month time period surrounding the ASQI implementation were included. The primary study outcome was median time in hours to aztreonam discontinuation among nonanaphylactic patients. Results After implementation of the ASQI, the percentage of patients continued on aztreonam for the duration of therapy was nearly cut in half, and a greater percentage of patients were switched to β-lactam antibiotics. No adverse effects associated with β-lactam therapy were observed in any study patient. Antimicrobial cost savings was not associated with any difference in clinical outcomes. Overall, hospitalwide aztreonam prescribing and aztreonam use declined. Institutional aztreonam orders per 1000 patient-days decreased from 1.5 to 1 after implementation of the ASQI. Additionally, hospitalwide aztreonam days of therapy per 1000 patient-days was reduced from 3.6 in the pre-ASQI period to 1.8 in the post-ASQI period. Conclusion An ASQI that included critical evaluation of patient-reported β-lactam allergies led to decreased aztreonam use, reduced antimicrobial expenditure, and similar clinical outcomes to those observed before implementation. |
| Databáze: | OpenAIRE |
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