Division of Rheumatology, Allergy, and Immunology, Department of Medicine,Massachusetts General Hospital, Boston, Massachusetts.
University of Pittsburgh School of Medicine,Pittsburgh, Pennsylvania.
Infect Control Hosp Epidemiol. 2019 May;40(5):528-535. doi: 10.1017/ice.2019.50. Epub 2019 Mar 27.
To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported β-lactam allergies.
Retrospective cohort study.
Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.
We evaluated β-lactam antibiotic test-dose outcomes, including adverse drug reactions (ADRs), hypersensitivity reactions (HSRs), and electronic health record (EHR) allergy record updates. HSR predictors were examined using a multivariable logistic regression model. Modification of the EHR allergy record after test doses considered relevant allergy entries added, deleted, and/or specified.
We identified 1,046 test-doses: 809 (77%) to cephalosporins, 148 (14%) to penicillins, and 89 (9%) to carbapenems. Overall, 78 patients (7.5%; 95% confidence interval [CI], 5.9%-9.2%) had signs or symptoms of an ADR, and 40 (3.8%; 95% CI, 2.8%-5.2%) had confirmed HSRs. Most HSRs occurred at the second (ie, full-dose) step (68%) and required no treatment beyond drug discontinuation (58%); 3 HSR patients were treated with intramuscular epinephrine. Reported cephalosporin allergy history was associated with an increased odds of HSR (odds ratio [OR], 2.96; 95% CI, 1.34-6.58). Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).
This antimicrobial stewardship intervention using β-lactam test-dose procedures was safe. Overall, 3.8% of patients with β-lactam allergy histories had an HSR; cephalosporin allergy histories conferred a 3-fold increased risk. Encouraging EHR documentation might improve this safe, effective, and practical acute-care antibiotic stewardship tool.
评估一项抗菌药物管理干预措施的安全性，该措施包括对报告β-内酰胺类过敏的住院患者根据电子指南进行的皮试挑战程序。
回顾性队列研究。
大型医疗保健系统，由 2016 年 4 月至 2017 年 12 月期间的 2 家学术医院和 3 家社区急性护理医院组成。
我们评估了β-内酰胺类抗生素皮试结果，包括药物不良反应（ADR）、过敏反应（HSR）和电子健康记录（EHR）过敏记录更新。使用多变量逻辑回归模型检查 HSR 预测因素。皮试后 EHR 过敏记录的修改考虑了添加、删除和/或指定相关过敏条目。
我们确定了 1046 例皮试：809 例（77%）为头孢菌素，148 例（14%）为青霉素，89 例（9%）为碳青霉烯类。总体而言，78 例患者（7.5%；95%置信区间[CI]，5.9%-9.2%）出现 ADR 体征或症状，40 例（3.8%；95% CI，2.8%-5.2%）确认发生 HSR。大多数 HSR 发生在第二（即全剂量）步骤（68%），除停药外无需治疗（58%）；3 例 HSR 患者接受了肌肉内肾上腺素治疗。报告的头孢菌素过敏史与 HSR 的发生几率增加相关（比值比[OR]，2.96；95% CI，1.34-6.58）。474 例患者（45%）的过敏记录进行了更新，其中记录指定（82%）、删除（16%）和添加（8%）。
这项使用β-内酰胺类皮试程序的抗菌药物管理干预措施是安全的。总体而言，3.8%有β-内酰胺类过敏史的患者发生 HSR；头孢菌素过敏史使 HSR 的发生风险增加了 3 倍。鼓励 EHR 记录可能会改进这种安全、有效和实用的急性护理抗生素管理工具。
