Jacobs Max W, Bremmer Derek N, Shively Nathan R, Moffa Matthew A, Trienski Tamara L, Carr Dustin R, Buchanan Carley A, Walsh Thomas L
Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA.
Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA.
Antimicrob Steward Healthc Epidemiol. 2023 Sep 8;3(1):e153. doi: 10.1017/ash.2023.432. eCollection 2023.
To assess the safety and efficacy of a novel beta-lactam allergy assessment algorithm managed by an antimicrobial stewardship program (ASP) team.
Retrospective analysis.
One quaternary referral teaching hospital and one tertiary care teaching hospital in a large western Pennsylvania health network.
Patients who received a beta-lactam challenge dose under the beta-lactam allergy assessment algorithm.
A beta-lactam allergy assessment protocol was designed and implemented by an ASP team. The protocol risk stratified patients' reported allergies to identify patients appropriate for a challenge with a beta-lactam antibiotic. This retrospective analysis assessed the safety and efficacy of this protocol among patients receiving a challenge dose from November 2017 to July 2021.
Over a 45-month period, 119 total patients with either penicillin or cephalosporin allergies entered the protocol. Following a challenge dose, 106 (89.1%) patients were treated with a beta-lactam. Eleven patients had adverse reactions to a challenge dose, one of which required escalation of care to the intensive care unit. Of the patients with an unknown or low-risk reported allergy, 7/66 (10.6%) had an observed adverse reaction compared to 3/42 (7.1%) who had an observed reaction with a reported high-risk or anaphylactic allergy.
Our implemented protocol was safe and effective, with over 90% of patients tolerating the challenge without incident and many going on to receive indicated beta-lactam therapy. This protocol may serve as a framework for other inpatient ASP teams to implement a low-barrier allergy assessment led by ASP teams.
评估由抗菌药物管理计划（ASP）团队管理的新型β-内酰胺类过敏评估算法的安全性和有效性。
回顾性分析。
宾夕法尼亚州西部一个大型医疗网络中的一家四级转诊教学医院和一家三级护理教学医院。
在β-内酰胺类过敏评估算法下接受β-内酰胺类激发剂量的患者。
ASP团队设计并实施了一项β-内酰胺类过敏评估方案。该方案根据风险对患者报告的过敏情况进行分层，以确定适合接受β-内酰胺类抗生素激发试验的患者。这项回顾性分析评估了2017年11月至2021年7月期间接受激发剂量的患者中该方案的安全性和有效性。
在45个月的时间里，共有119例对青霉素或头孢菌素过敏的患者进入该方案。给予激发剂量后，106例（89.1%）患者接受了β-内酰胺类治疗。11例患者对激发剂量有不良反应，其中1例需要升级到重症监护病房进行治疗。在报告的过敏情况未知或低风险的患者中，7/66（10.6%）观察到有不良反应，而在报告的高风险或过敏性过敏患者中，3/42（7.1%）观察到有不良反应。
我们实施的方案是安全有效的，超过90%的患者耐受激发试验且无不良事件发生，许多患者随后接受了指定的β-内酰胺类治疗。该方案可为其他住院ASP团队实施由ASP团队主导的低门槛过敏评估提供框架。
