Phillips E, Louie M, Knowles S R, Simor A E, Oh P I
Division of Clinical Pharmacology, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Am J Health Syst Pharm. 2000 Feb 15;57(4):339-45. doi: 10.1093/ajhp/57.4.339.
The cost-effectiveness of different approaches to antimicrobial prophylaxis for cardiovascular surgery patients labeled penicillin allergic was studied. A decision-analytic model was used to examine the cost-effectiveness of six strategies for antimicrobial prophylaxis in cardiovascular surgery patients at a tertiary care hospital. The strategies consisted of (1) giving vancomycin to all patients labeled penicillin allergic, (2) giving cefazolin to all patients labeled penicillin allergic, (3) giving vancomycin to all patients with a history suggesting an immunoglobulin E (IgE)-mediated reaction to penicillin and cefazolin to patients without such a history, (4) administering a penicillin skin test to patients with a history suggesting an IgE-mediated reaction to penicillin and giving vancomycin to patients with positive results and cefazolin to all others, (5) skin testing all patients labeled penicillin allergic and giving vancomycin to those with positive results and cefazolin to those with negative results, regardless of history, and (6) skin testing all patients and giving vancomycin to those with positive results or a history suggesting an IgE-mediated reaction to penicillin and cefazolin to all others. Giving cefazolin to all patients labeled penicillin allergic was the least expensive strategy but was associated with the highest rate of both anaphylactic and non-life-threatening serious reactions. Selective use of vancomycin in patients with a history suggesting an IgE-mediated reaction to penicillin was associated with an added cost and a slightly lower rate of anaphylaxis. Although skin-testing strategies may decrease both non-life-threatening and anaphylactic reactions, the incremental cost was high. When vancomycin was given to all patients labeled penicillin allergic, the incremental cost was very high. A decision-analytic model indicated that selective use of vancomycin is more cost-effective than indiscriminate use of vancomycin for surgical prophylaxis in cardiovascular surgery patients labeled penicillin allergic.
对标记为青霉素过敏的心血管手术患者采用不同抗菌药物预防方法的成本效益进行了研究。使用决策分析模型来检验一家三级护理医院中针对心血管手术患者的六种抗菌药物预防策略的成本效益。这些策略包括：(1) 对所有标记为青霉素过敏的患者给予万古霉素；(2) 对所有标记为青霉素过敏的患者给予头孢唑林；(3) 对所有有提示青霉素免疫球蛋白E（IgE）介导反应病史的患者给予万古霉素，对无此类病史的患者给予头孢唑林；(4) 对有提示青霉素IgE介导反应病史的患者进行青霉素皮肤试验，对结果呈阳性的患者给予万古霉素，对其他所有患者给予头孢唑林；(5) 对所有标记为青霉素过敏的患者进行皮肤试验，结果呈阳性的患者给予万古霉素，结果呈阴性的患者给予头孢唑林，无论其病史如何；(6) 对所有患者进行皮肤试验，结果呈阳性或有提示青霉素IgE介导反应病史的患者给予万古霉素，其他所有患者给予头孢唑林。对所有标记为青霉素过敏的患者给予头孢唑林是成本最低的策略，但与过敏反应和非危及生命的严重反应发生率最高相关。对有提示青霉素IgE介导反应病史的患者选择性使用万古霉素会增加成本，且过敏反应发生率略低。尽管皮肤试验策略可能会降低非危及生命的反应和过敏反应，但增量成本很高。当对所有标记为青霉素过敏的患者给予万古霉素时，增量成本非常高。决策分析模型表明，对于标记为青霉素过敏的心血管手术患者，选择性使用万古霉素在手术预防方面比不加区分地使用万古霉素更具成本效益。
