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Pharmacist-led improvement in perioperative antibiotic selection for patients with a penicillin allergy label.
Stonerock, Devon; Hallo-Carrasco, Alejandro; Edwards, Michael; Porter, Steven B; Epps, Kevin L; Gonzalez-Estrada, Alexei.
Afiliación
  • Stonerock D; Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA.
  • Hallo-Carrasco A; Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
  • Edwards M; Division of Advanced GI and Bariatric Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
  • Porter SB; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA.
  • Epps KL; Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA.
  • Gonzalez-Estrada A; Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
Am J Health Syst Pharm ; 80(9): e111-e118, 2023 04 19.
Article en En | MEDLINE | ID: mdl-36680795
PURPOSE: Surgical patients with a penicillin allergy label (PAL) are less likely to receive ß-lactams for surgical site infection (SSI) prophylaxis and more likely to receive second-line antibiotics, which may increase the risk of SSI, drug toxicities, and associated costs. We assessed the impact of implementing a pharmacist-led quality improvement project to increase the use of cefazolin as a first-line agent in this population. SUMMARY: After implementation of a pilot project in December 2021, all patients with a PAL and orders for preoperative antibiotics were risk stratified into high- or low-risk categories by a pharmacist. For the low-risk group, cefazolin was recommended. For the high-risk group, cefazolin was avoided and a second-line agent was administered. Our analysis compared 422 preintervention patients (August 15 to November 15, 2021) to 492 postintervention patients (December 15 to March 15, 2022). During the postintervention period, ß-lactam usage increased (from 12.6% to 37.8%, P < 0.001), while usage of vancomycin (45.5% vs 29.5%, P < 0.001) and other second-line antibiotics (87.4% vs 62.2%, P < 0.001) declined. There were no adverse reactions reported in the preintervention cohort, with 2 potential adverse reactions reported after the intervention (0% vs 0.4%, P = 0.190). Medication costs based on claims data were 50% to 80% lower for patients receiving cefazolin. CONCLUSION: In our cohort, a pharmacy-led antibiotic selection algorithm for patients with a PAL receiving perioperative antimicrobial prophylaxis resulted in increased use of ß-lactam antibiotics, decreased use of second-line antibiotics, and decreased costs without a significant change in the incidence of adverse reactions.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hipersensibilidad a las Drogas / Hipersensibilidad Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Am J Health Syst Pharm Asunto de la revista: FARMACIA / HOSPITAIS Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hipersensibilidad a las Drogas / Hipersensibilidad Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Am J Health Syst Pharm Asunto de la revista: FARMACIA / HOSPITAIS Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido