Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts
| Autor: | David A Enoch, Eimear T Brannigan, Cameron J Phillips, Michael E. P. Murphy, Fiona J. Cooke, Reem Santos, Bryony Dean Franklin, Mark Gilchrist, Alison Holmes |
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| Přispěvatelé: | National Institute for Health Research, Phillips, Cameron J, Gilchrist, Mark, Cooke, Fiona J, Franklin, Bryony D, Enoch, David A, Murphy, Michael E, Santos, Reem, Brannigan, Eimear T, Holmes, Alison H |
| Rok vydání: | 2019 |
| Předmět: |
Male
Allergy IMPACT Antibiotics THERAPY State Medicine Cohort Studies HOSPITALIZED-PATIENTS 0302 clinical medicine HISTORY Medicine 030212 general & internal medicine Practice Patterns Physicians' Aged 80 and over Cross Infection prescribing General Medicine Middle Aged PREVALENCE Anti-Bacterial Agents Community-Acquired Infections Cohort Practice Guidelines as Topic Urinary Tract Infections Female Guideline Adherence Life Sciences & Biomedicine medicine.drug Cohort study medicine.medical_specialty medicine.drug_class guideline-adherence Drug allergy Context (language use) Documentation Penicillins 1117 Public Health and Health Services Drug Hypersensitivity 03 medical and health sciences Medicine General & Internal General & Internal Medicine Internal medicine MANAGEMENT Humans Aged Immunology (Including Allergy) Science & Technology business.industry Soft Tissue Infections Research 1103 Clinical Sciences Guideline Pneumonia medicine.disease United Kingdom Penicillin LABELS Logistic Models penicillin 030228 respiratory system Multivariate Analysis business drug allergy 1199 Other Medical and Health Sciences |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectiveTo investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context.SettingData were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017.DesignCohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report.ParticipantsInpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs.ResultsA total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73) pConclusionsA relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP, received more guideline adherent antibiotics than those without allergy. Future studies investigating the clinical impact of penicillin allergy should include data on adherence to antibiotic guidelines. |
| Databáze: | OpenAIRE |
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