Swearingen Sara M, White Cyle, Weidert Sara, Hinds Melisande, Narro John P, Guarascio Anthony J
Baxter Regional Medical Center, Mountain Home, AR, USA.
Erlanger Health System, Chattanooga, TN, USA.
Int J Clin Pharm. 2016 Apr;38(2):213-7. doi: 10.1007/s11096-016-0248-y. Epub 2016 Jan 14.
Local antimicrobial susceptibility patterns should be considered for antimicrobial therapy decisions. Antibiogram data can guide beta-lactam antibiotic use in the presence of a penicillin allergy, particularly when allergic cross-reactivity among antibiotic agents is unlikely.
To evaluate the effect of a multidimensional antimicrobial stewardship intervention to improve antibiogram-driven antibiotic selection for patients with a reported penicillin allergy receiving aztreonam.
This historically controlled, quasi-experimental study compared historical aztreonam use with prospective antibiotic selection following a pharmacist-led intervention in patients with a penicillin allergy. The impact of this intervention on aztreonam use, antimicrobial selection, patient allergy profile updates, length of stay, in-hospital mortality, and antibiotic cost savings was assessed.
A significant reduction in median days of aztreonam therapy (4.0 vs. 2.0; p = 0.0001) and median days of therapy per 1000 patient days (14.5 vs. 9.3; p = 0.0001) was found in the intervention group.
A pharmacist-led antimicrobial stewardship intervention facilitated antibiogram-driven antibiotic therapy while reducing aztreonam use in patients without an anaphylactic penicillin allergy. Further trials are needed to assess the utility of similar antimicrobial stewardship interventions for patients with penicillin allergy.
抗菌治疗决策应考虑当地的抗菌药物敏感性模式。在存在青霉素过敏的情况下，抗菌谱数据可指导β-内酰胺类抗生素的使用，尤其是当抗菌药物之间不太可能发生过敏交叉反应时。
评估多维抗菌药物管理干预措施对改善报告有青霉素过敏的患者接受氨曲南治疗时依据抗菌谱选择抗生素的效果。
这项历史对照的准实验研究将氨曲南的历史使用情况与药师主导干预后青霉素过敏患者的前瞻性抗生素选择情况进行了比较。评估了该干预措施对氨曲南使用、抗菌药物选择、患者过敏情况更新、住院时间、院内死亡率和抗生素成本节约的影响。
干预组氨曲南治疗的中位天数（4.0天对2.0天；p = 0.0001）和每1000患者日的中位治疗天数（14.5天对9.3天；p = 0.0001）显著减少。
药师主导的抗菌药物管理干预措施促进了依据抗菌谱的抗生素治疗，同时减少了无青霉素过敏反应患者的氨曲南使用。需要进一步试验来评估类似的抗菌药物管理干预措施对青霉素过敏患者的效用。
