Abstract：
A guideline identifying when inpatients with penicillin or cephalosporin antibiotic allergy labels (PCAAL) can receive β-lactam antibiotics increased β-lactam receipt at a large northeastern US health care system.
To report outcomes of implementing a similar guideline and electronic order set (OS) at an independent academic health care system.
Penicillin/cephalosporin receipt (percentage of inpatients receiving full doses) and alternative antibiotic use (days of therapy per 1000 patient-days [DOT/1000PD]) were compared over 3 periods before (February 1, 2017, to January 31, 2018) and after guideline implementation (February 1, 2018, to January 31, 2019), and after OS implementation (February 1, 2019, to January 31, 2020) among inpatients with PCAAL admitted on medical services with access to guideline/OS and education (Medical-PCAAL, n = 8721), surgical services with access to guideline/OS without education (Surgical-PCAAL, n = 5069), and obstetrics/gynecology services without interventions (Ob/Gyn-PCAAL, n = 798) and inpatients without PCAAL admitted on the same services (Medical-No-PCAAL, n = 50,840; Surgical-No-PCAAL, n = 29,845; Ob/Gyn-No-PCAAL, n = 6109). χ2 tests were used to compare categorical variables, and analysis of variance was used to compare continuous and interrupted time series analyses (ITSA) to investigate the guideline/OS implementation effect on penicillin/cephalosporin receipt.
In the Medical-PCAAL group, penicillin/cephalosporin receipt increased (58%-68%, P < .001), specifically for cefazolin (8%-11%, P = .02) and third- to fifth-generation cephalosporins (43%-48%, P = .04), and aztreonam use decreased (12 DOT/1000PD, P = .03). In the Medical-No-PCAAL group, penicillin/cephalosporin receipt increased (88%-90%, P = .004), specifically for penicillin (40%-44%, P < .001), without changes in aztreonam use. Significant changes were not observed in these outcomes on surgical or obstetrics/gynecology services. Per ITSA, guideline/OS implementation was associated with increased penicillin/cephalosporin receipt in the Medical-PCAAL group only.
Guideline and OS implementation was associated with improved antibiotic stewardship on inpatient services that also received allergy education.
To report outcomes of implementing a similar guideline and electronic order set (OS) at an independent academic health care system.
Penicillin/cephalosporin receipt (percentage of inpatients receiving full doses) and alternative antibiotic use (days of therapy per 1000 patient-days [DOT/1000PD]) were compared over 3 periods before (February 1, 2017, to January 31, 2018) and after guideline implementation (February 1, 2018, to January 31, 2019), and after OS implementation (February 1, 2019, to January 31, 2020) among inpatients with PCAAL admitted on medical services with access to guideline/OS and education (Medical-PCAAL, n = 8721), surgical services with access to guideline/OS without education (Surgical-PCAAL, n = 5069), and obstetrics/gynecology services without interventions (Ob/Gyn-PCAAL, n = 798) and inpatients without PCAAL admitted on the same services (Medical-No-PCAAL, n = 50,840; Surgical-No-PCAAL, n = 29,845; Ob/Gyn-No-PCAAL, n = 6109). χ2 tests were used to compare categorical variables, and analysis of variance was used to compare continuous and interrupted time series analyses (ITSA) to investigate the guideline/OS implementation effect on penicillin/cephalosporin receipt.
In the Medical-PCAAL group, penicillin/cephalosporin receipt increased (58%-68%, P < .001), specifically for cefazolin (8%-11%, P = .02) and third- to fifth-generation cephalosporins (43%-48%, P = .04), and aztreonam use decreased (12 DOT/1000PD, P = .03). In the Medical-No-PCAAL group, penicillin/cephalosporin receipt increased (88%-90%, P = .004), specifically for penicillin (40%-44%, P < .001), without changes in aztreonam use. Significant changes were not observed in these outcomes on surgical or obstetrics/gynecology services. Per ITSA, guideline/OS implementation was associated with increased penicillin/cephalosporin receipt in the Medical-PCAAL group only.
Guideline and OS implementation was associated with improved antibiotic stewardship on inpatient services that also received allergy education.
摘要：
背景：一项指南，确定何时使用青霉素或头孢菌素抗生素过敏标签（PCAAL）的住院患者可以在美国东北部大型医疗保健系统中接受β-内酰胺抗生素增加β-内酰胺类药物的接收。目的：报告在独立的学术医疗保健系统中实施类似指南和电子订单集（OS）的结果。
方法：接受青霉素/头孢菌素（接受全剂量的住院患者百分比）和替代抗生素使用（每1000名患者治疗天数，DOT/1000PD)在之前的三个时期(2017年2月1日-2018年1月31日)进行了比较，指南实施后（2/1/3018-1/31/2019），并且在OS实施后（2/1/2019-1/31/2020），在接受医疗服务并获得指南/OS和教育的PCAAL住院患者中（Medical-PCAAL，n=8721),无需教育即可获得指南/OS的手术服务(Surgical-PCAAL，n=5069),和没有干预的产科/妇科服务(Ob/Gyn-PCAAL，n=798)和没有PCAAL的住院患者接受相同的服务(Medical-No-PCAAL，n=50840；无PCAAL手术，n=29845;Ob/Gyn-No-PCAAL,n=6109)。卡方检验用于比较分类变量，方差分析比较连续，和中断时间序列分析（ITSA），以调查指南/OS实施对青霉素/头孢菌素接收的影响。
结果：在Medical-PCAAL组中，青霉素/头孢菌素摄入量增加(58%至68%，p<0.001)，特别是头孢唑啉(8%至11%，p=0.02）和第3-5代头孢菌素（43%至48%，p=0.04),氨曲南使用量减少(12DOT/1000PD，p=0.03)。在医疗无PCAAL组中，青霉素/头孢菌素摄入量增加(88%至90%，p=0.004),特别是青霉素(40%到44%，p<0.001)，没有改变氨曲南的使用。在外科或妇产科服务中，未观察到这些结果的显着变化。根据ITSA，仅在Medical-PCAAL组中,指南/OS实施与青霉素/头孢菌素接收增加相关.
结论：指南和OS的实施与在接受过敏教育的住院服务中改善抗生素管理有关。
方法：接受青霉素/头孢菌素（接受全剂量的住院患者百分比）和替代抗生素使用（每1000名患者治疗天数，DOT/1000PD)在之前的三个时期(2017年2月1日-2018年1月31日)进行了比较，指南实施后（2/1/3018-1/31/2019），并且在OS实施后（2/1/2019-1/31/2020），在接受医疗服务并获得指南/OS和教育的PCAAL住院患者中（Medical-PCAAL，n=8721),无需教育即可获得指南/OS的手术服务(Surgical-PCAAL，n=5069),和没有干预的产科/妇科服务(Ob/Gyn-PCAAL，n=798)和没有PCAAL的住院患者接受相同的服务(Medical-No-PCAAL，n=50840；无PCAAL手术，n=29845;Ob/Gyn-No-PCAAL,n=6109)。卡方检验用于比较分类变量，方差分析比较连续，和中断时间序列分析（ITSA），以调查指南/OS实施对青霉素/头孢菌素接收的影响。
结果：在Medical-PCAAL组中，青霉素/头孢菌素摄入量增加(58%至68%，p<0.001)，特别是头孢唑啉(8%至11%，p=0.02）和第3-5代头孢菌素（43%至48%，p=0.04),氨曲南使用量减少(12DOT/1000PD，p=0.03)。在医疗无PCAAL组中，青霉素/头孢菌素摄入量增加(88%至90%，p=0.004),特别是青霉素(40%到44%，p<0.001)，没有改变氨曲南的使用。在外科或妇产科服务中，未观察到这些结果的显着变化。根据ITSA，仅在Medical-PCAAL组中,指南/OS实施与青霉素/头孢菌素接收增加相关.
结论：指南和OS的实施与在接受过敏教育的住院服务中改善抗生素管理有关。
