A multidimensional antimicrobial stewardship intervention targeting aztreonam use in patients with a reported penicillin allergy

Swearingen, Sara M.; White, Cyle; Weidert, Sara; Hinds, Melisande; Narro, John; Guarascio, Anthony J.

doi:10.1007/s11096-016-0248-y

Cited by 23 publications

(20 citation statements)

References 10 publications

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“…This study differs from previous pharmacist-led efforts to lower aztreonam use by disproving the penicillin allergy and removing it from the medical record [28, 29]. As aztreonam is expensive and often reserved for penicillin-allergic individuals, resolving the allergy in this specific inpatient population has great potential for immediate cost reductions, along with long-term savings obtained through future avoidance of this medication.…”

Section: Discussionmentioning

confidence: 83%

“…As most individuals reporting an allergy to penicillin in fact tolerate it, the majority of aztreonam use is expensive and avoidable. Prior pharmacist-led studies targeting aztreonam have reviewed allergy histories and directed providers’ therapeutic decisions without resolving the allergy label in the medical record [29, 30]. We sought to implement an institutional CDS guideline facilitating penicillin allergy testing in aztreonam recipients to assess its impact on antibiotic stewardship and cost.…”

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confidence: 99%

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Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Chen

Tarver

Alvarez

et al. 2018

Open Forum Infectious Diseases

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BackgroundPatients reporting penicillin allergy often receive unnecessary and costly broad-spectrum alternatives such as aztreonam with negative consequences. Penicillin allergy testing improves antimicrobial therapy but is not broadly used in hospitals due to insufficient testing resources and short-term expenses. We describe a clinical decision support (CDS) tool promoting pharmacist-administered penicillin allergy testing in patients receiving aztreonam and its benefits toward antimicrobial stewardship and costs.MethodsA CDS tool was incorporated into the electronic medical record, directing providers to order penicillin allergy testing for patients receiving aztreonam. An allergy-trained pharmacist reviewed orders placed through this new guideline and performed skin testing and oral challenges to determine whether these patients could safely take penicillin. Data on tests performed, antibiotic utilization, and cost-savings were compared with patients tested outside the new guideline as part of our institution’s standard stewardship program.ResultsThe guideline significantly increased penicillin allergy testing among patients receiving aztreonam from 24% to 85% (P < .001) while reducing the median delay between admission and testing completion from 3.31 to 1.05 days (P = 0.008). Patients tested under the guideline saw a 58% increase in penicillin exposure (P = .046). Institutional aztreonam administration declined from 2.54 to 1.47 administrations per 1000 patient-days (P = .016). Average antibiotic costs per patient tested before and after CDS decreased from $1265.81 to $592.08 USD, a 53% savings.ConclusionsTargeting penicillin allergy testing to patients on aztreonam yields therapeutic and economic benefits during a single admission. This provides a cost-effective model for inpatient testing.

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Section: Discussionmentioning

confidence: 83%

mentioning

confidence: 99%

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Chen

Tarver

Alvarez

et al. 2018

Open Forum Infectious Diseases

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“…Recent studies have highlighted increased use of restricted antibiotics and inappropriate prescriptions in those with antibiotic allergy labels [2]. The engagement of hospital pharmacists is essential; programs using direct allergy referrals from pharmacy departments have aided delabeling initiatives [12, 20]. A multidisciplinary model involving allergists, immunologists, ID physicians, and pharmacists is most likely to engage clinicians and deliver an effective service [21].…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotic allergy delabeling programs have been shown to effectively remove >90% of patient labels, and hence such programs could aid stewardship measures [9–12]. We distributed a survey to members of the Emerging Infections Network (EIN) of IDSA to ascertain current availability of antibiotic allergy services and the receptiveness for incorporating antibiotic allergy testing (AAT) strategies into stewardship programs.…”

mentioning

confidence: 99%

Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network

Trubiano

Beekmann

Worth

et al. 2016

Open Forum Infectious Diseases

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Antibiotic allergy testing (AAT) practices of Emerging Infections Network infectious disease physicians were surveyed. Although AAT was perceived to be necessary for removal of inappropriate or unnecessary allergy labels, there was limited access to any form of testing. In this study, we discuss current antibiotic allergy knowledge gaps and the development of AAT practices within antimicrobial stewardship programs, which will potentially improve antimicrobial prescribing.

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“…11,24 Alternative approaches have targeted penicillin allergy evaluation only for inpatients with particular infections, 21 or those prescribed particular beta-lactam alternative drugs (e.g., aztreonam). 11,25 …”

Section: Introductionmentioning

confidence: 99%

Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation

Blumenthal

Shenoy

Wolfson

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

111

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Addressing inaccurate penicillin allergies is encouraged as part of antibiotic stewardship in the inpatient setting. However, implementing interventions targeted at the 10–15% of inpatients reporting a prior penicillin allergy can pose substantial logistic challenges. We implemented a computerized guideline for patients with reported beta-lactam allergy at five hospitals within a single healthcare system in the Boston area. In this paper, we describe our implementation roadmap, including both successes achieved and challenges faced. We explain key implementation steps, including assembling a team, stakeholder engagement, developing or selecting an approach, spreading the change, establishing measures, and measuring impact. The objective is to detail the lessons learned while empowering others to be part of this important, multi-disciplinary work to improve the care of patients with reported beta-lactam allergies.

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A multidimensional antimicrobial stewardship intervention targeting aztreonam use in patients with a reported penicillin allergy

Cited by 23 publications

References 10 publications

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network

Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation

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