Initiative to reduce aztreonam use in patients with self-reported penicillin allergy: Effects on clinical outcomes and antibiotic prescribing patterns

Phan, Anthony M.; Allen, B.R.; Epps, Kevin; Alikhil, Maryam; Kamataris, Katherine; Tucker, Calvin

doi:10.2146/ajhp170400

Cited by 12 publications

(15 citation statements)

References 15 publications

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“…52,55 Therefore, multidisciplinary guidelines will train other specialists to improve allergy documentation. 46,52,[56][57][58] There are different computerized systems to assist physicians with their prescribing. However, they can cause an alert fatigue when physicians are exposed to too many alerts, and this can result in an override, ignoring or failing to respond appropriately even to important alerts which can result in serious harm.…”

Section: Mis L Ab Elling Influen Ce S Dhr Re Al In Ciden Cementioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Section: Mis L Ab Elling Influen Ce S Dhr Re Al In Ciden Cementioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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“…The most commonly targeted alternative antibiotic was aztreonam, but carbapenem use was a focus of 1 article. 21e23, 25,27,28 The history in these pathways was often standardized; for example, 1 group used a penicillin allergy screening tool, 25 and another created a penicillin allergy guidance card. 27…”

Section: History-basedmentioning

confidence: 99%

“…The most common single antibiotic targeted for reduction was aztreonam. 21,23,25,27,28,46,48 Other targeted antibiotics included carbapenems, vancomycin, linezolid, tigecycline, daptomycin, and moxifloxacin. 22,30,[32][33][34][35]46,49 Targeting Infections One PST-based pathway relied on reviews of each patient's infection and antibiotic data to select patients that would likely have a therapy change with a negative PST.…”

Section: Patient Selection Targeting Antibioticsmentioning

confidence: 99%

“…25 Posters and pocket cards were a common dissemination strategy. 25,27,30,[32][33][34]43 Pharmacists intercepted antibiotic orders to enforce guidelines. 30,[32][33][34]51 Electronic health record (EHR) order sets were created to assist pathway implementation.…”

Section: Infectious Diseasesmentioning

confidence: 99%

“…History-based pathways noted decreased aztreonam days of therapy, 21,25,28 reduced time to aztreonam discontinuation, 23 and lower frequency of aztreonam use (Table 1). 27 The challenge-based pathway in Australia noted ASP-restricted antibiotics decreased from 55% to 23% (Table 2). 29 Two PST-based pathways reported that their approach saved approximately 50 doses of vancomycin.…”

Section: Infectious Diseasesmentioning

confidence: 99%

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Acute care beta-lactam allergy pathways: approaches and outcomes

Wolfson

Huebner

Blumenthal

2019

Annals of Allergy, Asthma & Immunology

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Acute care beta-lactam allergy pathways are coordinated allergy assessment programs for hospitalized patients as an antibiotic stewardship tool, which can be based on the allergy history alone, or use the allergy history to guide procedures such as drug challenges and/or penicillin skin testing. Pathways commonly targeted patients likely to benefit from acute care penicillin allergy evaluations: patients on specific broadspectrum antibiotics, referred from Infectious Diseases specialists, and/or patients with specific infections or bacterial culture results. Acute care beta-lactam pathways were safe and report decreased alternative antibiotic use and increased beta-lactam antibiotic use. Instructions Credit can now be obtained, free for a limited time, by reading the review article and completing all activity components. Please note the instructions listed below: Review the target audience, learning objectives and all disclosures. Complete the pre-test. Read the article and reflect on all content as to how it may be applicable to your practice. Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 Credit TM. Minimum passing score on the post-test is 70%. Overall Purpose Participants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices. Learning Objectives At the conclusion of this activity, participants should be able to: Identify the benefits of inpatient beta-lactam allergy assessments. Describe different approaches to beta-lactam allergy pathways including the methods used to identify patients.

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Evaluation of a Pharmacist-Led Penicillin Allergy Assessment Program and Allergy Delabeling in a Tertiary Care Hospital

et al. 2021

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IMPORTANCE Penicillin allergies are frequently mislabeled, which may contribute to use of lesspreferred alternative antibiotics. OBJECTIVE To evaluate a pharmacist-led allergy assessment program's association with antimicrobial use and clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS A pharmacist-led allergy assessment program was launched in 2 phases (June 1, 2015, and November 2, 2016) at a single-center tertiary referral hospital. The longitudinal cross-sectional study included all study period adult admissions; hospitalwide outcomes were assessed by segmented regression. Individual outcomes were assessed within an embedded propensity score-matched case-control study of inpatients undergoing comprehensive allergy assessment following self-report of penicillin allergy. Analysis occurred from March 1, 2020, to February 29, 2020.EXPOSURES The longitudinal study analyzed hospital-level outcomes over 3 periods: preintervention (15 months), phase 1 (structured allergy history alone, 16 months), and phase 2 (comprehensive assessment including penicillin skin testing, 52 months). The case-control study defined cases as individuals undergoing comprehensive allergy assessment. MAIN OUTCOMES AND MEASURESHospital-level outcomes included antibiotic days of therapy per 1000 patient-days and hospital-acquired Clostridioides difficile infection (CDI) incidence per 10 000 patient-days. Individual outcomes included antibiotic selection, overall survival, and CDI-free survival.RESULTS Longitudinal analysis spanned 2014-2020 (median admissions, 46 416 per year; interquartile range [IQR], 46 001-50 091 per year). Hospitalwide, allergy histories were temporally associated with decreased use of nonpenicillin alternative antibiotics (rate ratio, 0.87; 95% CI, 0.79-0.97) and high-CDI-risk antibiotics (rate ratio, 0.91; 95% CI, 0.85-0.98). Penicillin skin testing was temporally associated with lower hospital-acquired CDI rates (rate ratio, 0.61; 95% CI, 0.43-0.86).The embedded case-control study included 272 cases and 819 controls. Median age was 63 years (interquartile range, 51-73 years), 553 (50.7%) patients were women, and 229 (21.0%) patients were Black. Allergy-assessed patients were less likely to receive high-CDI-risk antibiotics at discharge (odds ratio, 0.66; 95% CI, 0.44-0.98). Estimated reductions in mortality (hazard ratio, 0.77; 95% CI, 0.55-1.07) and hospital-acquired CDI risk (hazard ratio, 0.53; 95% CI, 0.18-1.55) were not statistically significant. CONCLUSIONS AND RELEVANCEPharmacist-led allergy assessments may be associated with reduced high-CDI-risk antibiotic use at both hospitalwide and individual levels. Although individual (continued) Key Points Question Are pharmacist-led allergy assessments associated with improved antibiotic selection and reduced Clostridioides difficile infection rates? Findings In this longitudinal crosssectional study examining 46 416 admissions, allergy assessments and penicillin skin testing were temporally associated with reduced use of high Clostridioides difficile infection-risk a...

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Initiative to reduce aztreonam use in patients with self-reported penicillin allergy: Effects on clinical outcomes and antibiotic prescribing patterns

Abstract: After implementation of an initiative to encourage the use of cephalosporins rather than aztreonam in patients with SRPA, the rate of clinical response and cephalosporin use increased and rates of exposure to aztreonam and fluoroquinolones decreased.

Cited by 12 publications

References 15 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

Acute care beta-lactam allergy pathways: approaches and outcomes

Evaluation of a Pharmacist-Led Penicillin Allergy Assessment Program and Allergy Delabeling in a Tertiary Care Hospital

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