Improving Antibiotic Stewardship for Inpatients with Reported Beta-Lactam Allergies and Limited Access to Penicillin Skin Testing.
Improving Antibiotic Stewardship for Inpatients with Reported Beta-Lactam Allergies and Limited Access to Penicillin Skin Testing.
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DOI：
10.1016/j.jcjq.2021.12.001
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发表时间：
2022-03
影响因子：
2.3
通讯作者：
Simon MS
中科院分区：
文献类型：
--
作者：
Berger RE;Singh HK;Loo AS;Cooley V;Osorio SN;Lee JI;Simon MS
青霉素过敏是常见的报告，但真正的过敏是罕见的。报告β-内酰胺过敏的住院患者通常使用替代抗生素治疗。青霉素皮肤测试（PST）并不普遍适用于住院患者。我们设计了一个四阶段的质量改进项目，旨在增加在两家医院安全接受β-内酰胺抗生素的β-内酰胺过敏报告的医疗服务住院患者的百分比，这些医院的PST有限。首先，我们更新了我们的医院指南，允许头孢菌素分级挑战，而无需先前的PST。其次，我们对医生、医师助理和护士进行了关于新指南和β-内酰胺过敏分类和管理的教育。第三，我们设计了一个口袋卡，以加强教育。最后，我们使用抗菌药物管理软件筛选我们的每日普查，以确定改善报告β-内酰胺过敏患者管理的机会。我们观察到，在报告β-内酰胺类过敏的患者中，接受β-内酰胺类抗生素（不包括碳青霉烯类）的患者百分比增加了29%，从基线时的42.2%（470/1115）增加到项目期间的54.5%（379/696; p < 0.001）。替代抗生素的使用减少，医院发病的艰难梭菌病例没有变化，传染病或过敏咨询的数量没有增加。在项目期间，分级激发次数增加，无任何速发型过敏反应事件。一项旨在改善β-内酰胺过敏管理和分级挑战的多阶段质量改进项目导致β-内酰胺利用率增加，而速发型过敏反应没有增加，即使PST的使用有限。
Penicillin allergy is commonly reported, but true allergy is rare. Inpatients with reported beta-lactam allergy are often treated with alternative antibiotics. Penicillin skin testing (PST) is not universally available for inpatients. We designed a four-phase quality improvement project aimed to increase the percentage of inpatients on medical services with reported beta-lactam allergy who safely receive beta-lactam antibiotics at two hospitals with limited access to PST. First, we updated our hospital guideline to allow for cephalosporin graded challenge without antecedent PST. Second, we educated physicians, physician assistants, and nurses about the new guideline and beta-lactam allergy classification and management. Third, we designed a pocket card to reinforce the education. Last, we used antimicrobial stewardship software to screen our daily census to identify opportunities to improve management of patients with reported beta-lactam allergies. We observed a 29% increase in the percentage of patients who received beta-lactam antibiotics (excluding carbapenems) among those with reported beta-lactam allergy, from 42.2% (470/1115) at baseline to 54.5% (379/696; p < 0.001) during the project period. There was a decrease in the use of alternative antibiotics, no change in hospital-onset Clostridioides difficile cases, and no increase in the number of infectious disease or allergy consults. The number of graded challenges increased during the project period, without any anaphylaxis events. A multiphase quality improvement project aimed to improve management of beta-lactam allergies and access to graded challenges led to an increase in beta-lactam utilization without an increase in anaphylaxis, even with limited access to PST.
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DOI：
10.1016/j.jcjq.2018.09.002
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影响因子：
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