Lee C E, Zembower T R, Fotis M A, Postelnick M J, Greenberger P A, Peterson L R, Noskin G A
Northwestern Memorial Hospital, Galter Carriage House, Room 701B, 215 E Chicago Ave, Chicago, IL 60611, USA.
Arch Intern Med. 2000 Oct 9;160(18):2819-22. doi: 10.1001/archinte.160.18.2819.
The development of antimicrobial guidelines is one way in which institutions attempt to control emerging resistance, but the real challenge falls on promoting and ensuring adherence to these guidelines. Investigating reasons for the prescribing of alternative antimicrobial agents outside of these guidelines is crucial for modifying practices that may adversely impact institutional antimicrobial goals.
Retrospective cross-referencing of computerized pharmacy printouts and concurrent manual medical record review.
Approximately 25% (470/1893) of the patients requiring antimicrobial therapy reported an allergy to at least 1 antimicrobial agent. The most commonly reported antimicrobial allergy was penicillin (295/1893 [15.6%]). Eighty-five patients (18.1%) reported having an allergy to 2 or more antimicrobial agents. Only 4% (27/601) of the reported antimicrobial allergies contained documentation as to the nature of the specific allergic reactions, while a manual medical record review revealed that 32% (23/73) of the antimicrobial allergies contained documentation of the specific allergic reaction. Ninety-eight (39. 7%) of 247 patients reporting an allergy only to penicillin and/or cephalosporin received vancomycin in comparison with 247 (17.4%) of 1423 patients without any antimicrobial allergies (P<.001). Similarly, 53 (21.5%) of 247 patients with reported penicillin and/or cephalosporin allergies received levofloxacin compared with 114 (8.0%) of 1423 patients without any antimicrobial allergy (P<. 001).
The incidence of penicillin allergy at our institution exceeds population averages. This finding, in combination with limited documentation of drug allergies, appears to lead to the prescribing of alternative antimicrobial agents that do not fit into institutional antimicrobial guidelines and, in some instances, may put the patient at risk for infection and/or colonization with resistant organisms. Use of these alternative agents may adversely impact the ability to manage emerging antimicrobial resistance.
制定抗菌药物指南是医疗机构试图控制新出现的耐药性的一种方式，但真正的挑战在于促进并确保对这些指南的遵守。调查在这些指南之外开具替代抗菌药物的原因对于改变可能对机构抗菌目标产生不利影响的做法至关重要。
对计算机化药房打印件进行回顾性交叉引用，并同时进行人工病历审查。
需要抗菌治疗的患者中约25%（470/1893）报告对至少一种抗菌药物过敏。最常报告的抗菌药物过敏是青霉素（295/1893 [15.6%]）。85名患者（18.1%）报告对两种或更多种抗菌药物过敏。报告的抗菌药物过敏中只有4%（27/601）包含关于特定过敏反应性质的记录，而人工病历审查显示32%（23/73）的抗菌药物过敏包含特定过敏反应的记录。在仅报告对青霉素和/或头孢菌素过敏的247名患者中，98名（39.7%）接受了万古霉素治疗，而在没有任何抗菌药物过敏的1423名患者中，247名（17.4%）接受了万古霉素治疗（P<0.001）。同样，在报告对青霉素和/或头孢菌素有过敏反应的247名患者中，53名（21.5%）接受了左氧氟沙星治疗，而在没有任何抗菌药物过敏的1423名患者中，114名（8.0%）接受了左氧氟沙星治疗（P<0.001）。
我们机构青霉素过敏的发生率超过了人群平均水平。这一发现，再加上药物过敏记录有限，似乎导致了不符合机构抗菌指南的替代抗菌药物的开具，在某些情况下，可能使患者面临感染和/或耐药菌定植的风险。使用这些替代药物可能会对管理新出现的抗菌药物耐药性的能力产生不利影响。
