Hanssen P, Nieuwhof C, van Mens S, van de Plas A, Horstman K
Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Department of Allergology and Clinical Immunology, Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
JAC Antimicrob Resist. 2021 Jun 15;3(2):dlab077. doi: 10.1093/jacamr/dlab077. eCollection 2021 Jun.
Suboptimal antibiotic prescriptions in patients with an antibiotic allergy label lead to increased incidence of adverse events and antimicrobial resistance (AMR). An antibiotic allergy protocol was developed in a Dutch academic hospital guiding optimal and safe antibiotic use in potentially penicillin-allergic patients. Informed by previous studies of implementation processes in clinical care, we studied the implementation of this protocol.
Medical professionals in the Departments of Surgery, Internal Medicine, and Pulmonary Care were interviewed. Additionally, focus groups were conducted in Internal Medicine and Pulmonary Care to validate the outcomes of the interviews.
Dissemination of the protocol via the regular online hospital-wide guidance system did not have a significant impact on the knowledge about or use of the protocol. If healthcare professionals found the protocol, they thought it was valuable and expressed trust in the expertise embodied in it. However, its use in practice was rather minimal. Interviewees doubted the accuracy of the patient's histories about their previous adverse drug reactions, and/or the information in their medical records and concluded that adherence to the expert guideline was needlessly risky. They felt the acute allergic reaction risk for a patient outweighed the risk of suboptimal therapy or future AMR.
For successful implementation and dissemination of the protocol, the accessibility of the protocol, the information about the actual risks of following the protocol and the registration of allergic history should be improved. However, whether this actually results in improvement also depends on changes in the hospital culture and organization.
有抗生素过敏标识的患者接受的抗生素处方欠佳，会导致不良事件发生率和抗菌药物耐药性（AMR）增加。荷兰一家学术医院制定了一项抗生素过敏方案，以指导潜在青霉素过敏患者合理、安全地使用抗生素。基于以往对临床护理实施过程的研究，我们对该方案的实施情况进行了研究。
对外科、内科和肺部护理科的医学专业人员进行了访谈。此外，在内科和肺部护理科开展了焦点小组讨论，以验证访谈结果。
通过常规的全院在线指导系统传播该方案，对方案的知晓度或使用情况没有产生显著影响。如果医护人员找到了该方案，他们认为它很有价值，并对其中体现的专业知识表示信任。然而，其在实际中的使用相当少。受访者怀疑患者既往药物不良反应病史的准确性，和/或其病历中的信息，并得出结论，遵循专家指南存在不必要的风险。他们认为患者发生急性过敏反应的风险大于治疗欠佳或未来出现AMR的风险。
为了成功实施和传播该方案，应提高方案的可及性、遵循该方案的实际风险信息以及过敏史的登记。然而，这是否真的能带来改善还取决于医院文化和组织的变化。
