Staicu Mary L, Brundige Mary Lourdes, Ramsey Allison, Brown Jack, Yamshchikov Alexandra, Peterson Derick R, Baran Andrea, Laguio-Vila Maryrose
Pharmacy Department, Rochester General Hospital, Rochester, NY.
Allergy and Immunology, Rochester General Hospital, Rochester, NY.
Am J Health Syst Pharm. 2016 Mar 1;73(5):298-306. doi: 10.2146/ajhp150288.
The implementation of a penicillin allergy screening tool to optimize the use of aztreonam is described.
This study was conducted at a 528-bed tertiary referral community teaching facility and compared the use of aztreonam in patients before and after the implementation of a multipronged intervention consisting of a penicillin allergy screening tool (PAST), education, order set decision support, and prospective review of aztreonam orders by the antimicrobial stewardship team and clinical pharmacists. Patients for whom aztreonam was prescribed at any time during their presentation to the hospital January 1-June 30, 2013 (preintervention period), and September 1, 2013-February 28, 2014 (postintervention period) were eligible for inclusion. Primary outcomes included total and inappropriate aztreonam usage. Secondary outcomes included cost avoidance and safety.
A total of 496 aztreonam orders were reviewed. The total number of days of therapy (DOT) with aztreonam significantly decreased from 9.5 per 1,000 patient-days in the preintervention group to 4.4 per 1,000 patient-days in the postintervention group (p < 0.0001). The number of inappropriate aztreonam DOT decreased from 4.0 per 1,000 patient days to 0.8 per 1,000 patient-days (p < 0.0001). The median number of inappropriate aztreonam doses decreased significantly in the postintervention period, as did inappropriate aztreonam DOT (p < 0.0001 for both comparisons). An estimated cost avoidance of $60,000-$100,000 was realized, depending on the alternative antibiotic selected.
Implementation of the PAST and provider and pharmacist education reduced the use of aztreonam by promoting the first-line use of β-lactam alternatives.
描述一种用于优化氨曲南使用的青霉素过敏筛查工具的实施情况。
本研究在一家拥有528张床位的三级转诊社区教学机构开展，比较了在实施由青霉素过敏筛查工具（PAST）、教育、医嘱集决策支持以及抗菌药物管理团队和临床药师对氨曲南医嘱进行前瞻性审查组成的多管齐下干预措施前后患者使用氨曲南的情况。2013年1月1日至6月30日（干预前期）以及2013年9月1日至2014年2月28日（干预后期）期间在医院就诊时任何时间开具了氨曲南处方的患者均符合纳入条件。主要结局包括氨曲南的总使用量和不恰当使用量。次要结局包括成本节约和安全性。
共审查了496份氨曲南医嘱。氨曲南的总治疗天数（DOT）从干预前期每1000患者日9.5天显著降至干预后期每1000患者日4.4天（p<0.0001）。不恰当的氨曲南DOT从每1000患者日4.0天降至每1000患者日0.8天（p<0.0001）。干预后期，不恰当的氨曲南剂量中位数显著下降，不恰当的氨曲南DOT也显著下降（两项比较p均<0.0001）。根据所选替代抗生素的不同，估计节约成本60,000 - 100,000美元。
PAST的实施以及对医疗服务提供者和药师的教育通过促进β-内酰胺类替代药物的一线使用减少了氨曲南的使用。
