Maguire Michelle, Hayes Bryan D, Fuh Lanting, Elshaboury Ramy, Gandhi Ronak G, Bor Sarah, Shenoy Erica S, Wolfson Anna R, Mancini Christian M, Blumenthal Kimberly G
Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
World Allergy Organ J. 2020 Jan 7;13(1):100093. doi: 10.1016/j.waojou.2019.100093. eCollection 2020 Jan.
Facilitating beta-lactam antibiotic use in patients reporting beta-lactam allergies in acute care settings is important to individual patient outcomes and public health; however, few initiatives have targeted the Emergency Department (ED) setting.
We implemented pathways for patients reporting prior penicillin and/or cephalosporin hypersensitivity as part of a hospital guideline in the ED of a large academic medical center in the United States. We described beta-lactam test doses, pathway compliance, hypersensitivity reactions (HSRs), and allergy record updating associated with ED-administered beta-lactam test doses from October 2016 to June 2018.
310 beta-lactam antibiotic test doses were administered to patients with penicillin and/or cephalosporin allergy histories in the study period (average volume 15/month [standard deviation 4]). Test doses were to cephalosporins (85%), penicillins (12%), and carbapenems (4%). 219 (71%) of test doses were compliant with the pathways. Ten patients (3.2%; 95% CI 1.6%-5.9%) had HSRs; five HSR patients (50%) had beta-lactams administered that were not pathway compliant. The allergy record was updated in 146 (47%) of patients, with improvement over the study period (p < 0.001).
Inpatient approaches to prescribing beta-lactams in patients reporting beta-lactam allergies can be operationalized in the ED. Additional efforts are required to ensure guideline compliance and appropriate allergy documentation.
在急症护理环境中，促进对报告有β-内酰胺类抗生素过敏的患者使用β-内酰胺类抗生素，对患者个体预后和公共卫生都很重要；然而，很少有举措针对急诊科（ED）环境。
作为美国一家大型学术医疗中心急诊科医院指南的一部分，我们为报告有青霉素和/或头孢菌素过敏史的患者实施了相应路径。我们描述了β-内酰胺类试验剂量、路径依从性、过敏反应（HSR）以及与2016年10月至2018年6月急诊科给予的β-内酰胺类试验剂量相关的过敏记录更新情况。
在研究期间，对有青霉素和/或头孢菌素过敏史的患者给予了310次β-内酰胺类抗生素试验剂量（平均每月15次[标准差4]）。试验剂量用于头孢菌素（85%）、青霉素（12%）和碳青霉烯类（4%）。219次（71%）试验剂量符合路径要求。10名患者（3.2%；95%CI 1.6%-5.9%）发生了过敏反应；5名发生过敏反应的患者（50%）接受的β-内酰胺类药物给药不符合路径要求。146名（47%）患者的过敏记录得到更新，且在研究期间有所改善（p<0.001）。
对于报告有β-内酰胺类过敏的患者，住院患者开具β-内酰胺类药物的方法可在急诊科实施。需要进一步努力以确保指南依从性和适当的过敏记录。
