دورية أكاديمية
Impact of an Inpatient Allergy Guideline on β-Lactam and Alternative Antibiotic Use.
| العنوان: | Impact of an Inpatient Allergy Guideline on β-Lactam and Alternative Antibiotic Use. |
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| المؤلفون: | Otani IM; Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California San Francisco, San Francisco, Calif. Electronic address: iris.otani@ucsf.edu., Tang M; Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California San Francisco, San Francisco, Calif., Wang L; Department of Quality-Hospital Epidemiology and Infection Prevention, University of California San Francisco, San Francisco, Calif., Anstey KM; Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, Ore., Hilts-Horeczko A; Department of Pharmaceutical Services, University of California San Francisco, San Francisco, Calif., Li F; Department of Pharmaceutical Services, University of California San Francisco, San Francisco, Calif., Le VP; Health Clinical Systems, University of California San Francisco, San Francisco, Calif., Lee M; The Center for Nursing Excellence and Innovation, University of California San Francisco, San Francisco, Calif., Bystritsky R; Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, Calif., Mulliken JS; Infectious Disease Section, Medical Service, San Francisco Veterans' Affairs Medical Center, San Francisco, Calif., Wattier RL; Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California San Francisco, San Francisco, Calif., Blumenthal KG; Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass., Doernberg SB; Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, Calif. |
| المصدر: | The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2023 Aug; Vol. 11 (8), pp. 2557-2567.e6. Date of Electronic Publication: 2023 May 12. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101597220 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2213-2201 (Electronic) NLM ISO Abbreviation: J Allergy Clin Immunol Pract Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Elsevier Inc., [2013]- |
| مواضيع طبية MeSH: | Drug Hypersensitivity*/drug therapy , Hypersensitivity*/drug therapy, Humans ; Anti-Bacterial Agents/adverse effects ; beta-Lactams/adverse effects ; Inpatients ; Aztreonam ; Penicillins/adverse effects ; Cephalosporins/therapeutic use ; Cephalosporins/adverse effects ; Retrospective Studies |
| مستخلص: | Background: A guideline identifying when inpatients with penicillin or cephalosporin antibiotic allergy labels (PCAAL) can receive β-lactam antibiotics increased β-lactam receipt at a large northeastern US health care system. Objective: To report outcomes of implementing a similar guideline and electronic order set (OS) at an independent academic health care system. Methods: Penicillin/cephalosporin receipt (percentage of inpatients receiving full doses) and alternative antibiotic use (days of therapy per 1000 patient-days [DOT/1000PD]) were compared over 3 periods before (February 1, 2017, to January 31, 2018) and after guideline implementation (February 1, 2018, to January 31, 2019), and after OS implementation (February 1, 2019, to January 31, 2020) among inpatients with PCAAL admitted on medical services with access to guideline/OS and education (Medical-PCAAL, n = 8721), surgical services with access to guideline/OS without education (Surgical-PCAAL, n = 5069), and obstetrics/gynecology services without interventions (Ob/Gyn-PCAAL, n = 798) and inpatients without PCAAL admitted on the same services (Medical-No-PCAAL, n = 50,840; Surgical-No-PCAAL, n = 29,845; Ob/Gyn-No-PCAAL, n = 6109). χ 2 tests were used to compare categorical variables, and analysis of variance was used to compare continuous and interrupted time series analyses (ITSA) to investigate the guideline/OS implementation effect on penicillin/cephalosporin receipt. Results: In the Medical-PCAAL group, penicillin/cephalosporin receipt increased (58%-68%, P < .001), specifically for cefazolin (8%-11%, P = .02) and third- to fifth-generation cephalosporins (43%-48%, P = .04), and aztreonam use decreased (12 DOT/1000PD, P = .03). In the Medical-No-PCAAL group, penicillin/cephalosporin receipt increased (88%-90%, P = .004), specifically for penicillin (40%-44%, P < .001), without changes in aztreonam use. Significant changes were not observed in these outcomes on surgical or obstetrics/gynecology services. Per ITSA, guideline/OS implementation was associated with increased penicillin/cephalosporin receipt in the Medical-PCAAL group only. Conclusion: Guideline and OS implementation was associated with improved antibiotic stewardship on inpatient services that also received allergy education. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Antibiotic allergy; Antibiotic stewardship; Aztreonam; Cephalosporin allergy; Graded challenge; Guideline; PCN allergy; Quality improvement; Stewardship; β-Lactam allergy |
| المشرفين على المادة: | 0 (Anti-Bacterial Agents) 0 (beta-Lactams) G2B4VE5GH8 (Aztreonam) 0 (Penicillins) 0 (Cephalosporins) |
| تواريخ الأحداث: | Date Created: 20230514 Date Completed: 20230811 Latest Revision: 20230811 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.jaip.2023.04.051 |
| PMID: | 37182569 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 2213-2201 |
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| DOI: | 10.1016/j.jaip.2023.04.051 |