Department of Pharmacy Services, Henry Ford Macomb Hospital, Clinton Township, MI, USA.
Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
Am J Health Syst Pharm. 2021 Aug 30;78(Supplement_3):S76-S82. doi: 10.1093/ajhp/zxab218.
Patients with a reported β-lactam allergy (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSIs), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview service in the preoperative setting.
A pharmacist performed BLA clarification telephone interviews before elective procedures from November 2018 to March 2019. On the basis of allergy history and a decision algorithm, first-line preoperative antibiotics, alternative antibiotics, or allergy testing referral was recommended. The pharmacist intervention (PI) group was compared to a standard of care (SOC) group who underwent surgery from November 2017 to March 2018.
Eighty-seven patients were included, with 50 (57%) and 37 (43%) in the SOC and PI groups, respectively. The most common surgeries included orthopedic surgery in 41 patients (47%) and neurosurgery in 17 patients (20%). In the PI group, all BLA labels were updated after interview. Twenty-three patients were referred for allergy testing, 12 of the 23 (52%) completed BLA testing, and penicillin allergies were removed for 9 of the 12 patients. Overall, 28 of the 37 (76%) pharmacy antibiotic recommendations were accepted. Cefazolin use significantly increased from 28% to 65% after the intervention (P = 0.001). SSI occurred in 5 (10%) patients in the SOC group and no patients in the PI group (P = 0.051). All of these SSIs were associated with alternative antibiotics. Incidence of AKI and CDI was similar between the groups. No allergic reactions occurred in either group.
Implementation of a pharmacy-driven BLA reconciliation significantly increased β-lactam preoperative use without negative safety outcomes.
有β-内酰胺类药物过敏史（BLA）的患者通常会接受替代围手术期抗生素预防，这增加了手术部位感染（SSI）、急性肾损伤（AKI）和艰难梭菌感染（CDI）的风险。本研究旨在实施并评估药师主导的术前 BLA 澄清访谈服务。
2018 年 11 月至 2019 年 3 月期间，药师对择期手术前进行 BLA 澄清电话访谈。根据过敏史和决策算法，推荐使用一线术前抗生素、替代抗生素或过敏检测转诊。将药师干预（PI）组与 2017 年 11 月至 2018 年 3 月接受手术的标准护理（SOC）组进行比较。
共纳入 87 例患者，SOC 组和 PI 组分别为 50 例（57%）和 37 例（43%）。最常见的手术包括 41 例骨科手术（47%）和 17 例神经外科手术（20%）。在 PI 组，所有 BLA 标签在访谈后均进行了更新。23 例患者被转诊进行过敏检测，其中 12 例（52%）完成了 BLA 检测，12 例中有 9 例青霉素过敏被消除。总体而言，37 例患者中有 28 例（76%）接受了药房抗生素建议。干预后头孢唑林的使用率从 28%显著增加至 65%（P = 0.001）。SOC 组有 5 例（10%）患者发生 SSI，PI 组无患者发生 SSI（P = 0.051）。所有这些 SSI 均与替代抗生素有关。两组 AKI 和 CDI 的发生率相似。两组均未发生过敏反应。
实施药房驱动的 BLA 协调显著增加了β-内酰胺类药物术前使用率，且无不良安全结局。
