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Implementation and outcomes of beta-lactam allergy management protocol at a comprehensive cancer center.
So, Wonhee; Khalak, Sohanabanu I; Ho, Stephanie; Ross, Justine Abella; Dadwal, Sanjeet S; Puing, Alfredo G; Nanayakkara, Deepa D; Kaur, Avneet; Taplitz, Randy A; Dickter, Jana K.
Afiliación
  • So W; College of Pharmacy, Western University of Health Sciences, 309 E. 2nd St, Pomona, CA, 91766, USA. wso@coh.org.
  • Khalak SI; Department of Pharmacy, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA. wso@coh.org.
  • Ho S; CVS Pharmacy, Los Angeles, United States.
  • Ross JA; Department of Pharmacy, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
  • Dadwal SS; Department of Pharmacy, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
  • Puing AG; Department of Medicine, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
  • Nanayakkara DD; Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
  • Kaur A; Department of Medicine, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
  • Taplitz RA; Department of Medicine, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
  • Dickter JK; Department of Medicine, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
Infection ; 2024 Jun 21.
Article en En | MEDLINE | ID: mdl-38907094
ABSTRACT

PURPOSE:

Beta-lactam allergy (BLA) is associated with increased broad-spectrum antibiotic (Br-ABX) use and worse clinical outcomes. We evaluated our hospital-wide BLA protocol (BLA-P) that used following categories intolerance, low-risk, and high-risk.

METHODS:

Hospitalized adult patients with listed BLA during 10/2021-12/2022 were eligible. Exclusions were critically ill, surgical, hospice or comfort care, or non-verbal patients. Assessment was counted each time a pharmacist evaluated BLA. Interventions were no further action (high-risk allergy, patient refusal, unstable clinical status), updated allergy label, or delabeled. Delabeling was done either based on antibiotic history (direct-delabeling), or via test-dose challenge for low-risk patients. Br-ABX usage was compared in the unique delabeled patients the empiric antibiotic use 90 days post-delabeling versus pre-delabeling using McNemar test (SPSS).

RESULTS:

A total of 700 assessments in 631 patients were identified. 441 assessments in 377 patients (median 63 years-old, 41% male, 50% hematological cancer) met inclusion criteria. The assessments revealed 9% intolerance, 55% low-risk, 23% high-risk and 13% unknown reaction. Interventions resulted in no further action 7%, updated label 72%, and delabeling 21%. 65% of the delabeling was via direct-delabeling and 35% test-dose challenge. Among patients who received a test-dose challenge, 36/36(97%) had no documented allergic reactions, and 1/26(3%) developed a mild rash. The use of aztreonam (pre-delabeling 28% vs. post-delabeling 1.2%, p < 0.001) and meropenem (13% vs. 2.4%, p = 0.022) significantly decreased while cefepime (24% vs. 50%, p = 0.001) and piperacillin-tazobactam (3.7% vs. 22%, p < 0.001) increased after delabeling.

CONCLUSION:

BLA-P led to 21% delabeling, which resulted in increased preferred Br-ABX and decrease in aztreonam/meropenem use among delabeled patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Infection Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Infection Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Alemania