目的:β-内酰胺过敏(BLA)与广谱抗生素(Br-ABX)使用增加和临床结局恶化有关。我们评估了我们的医院范围内的BLA协议(BLA-P),使用以下类别:不耐受,低风险,和高风险。
方法:在2021年10月12日至2022年12月期间住院的成年BLA患者符合资格。排除病危,外科,临终关怀或舒适护理,或非语言患者。每次药剂师评价BLA时对评价进行计数。干预措施没有进一步的行动(高风险过敏,病人拒绝,不稳定的临床状态),更新过敏标签,或者去标签。去标签是根据抗生素病史(直接去标签),或通过低风险患者的测试剂量挑战。在独特的去标签患者中比较了Br-ABX的使用:去标签后90天的经验性抗生素使用与使用McNemar测试(SPSS)的去标签前。
结果:对631例患者进行了700项评估。对377例患者进行了441次评估(中位63岁,41%男性,50%血液肿瘤)符合纳入标准。评估显示9%的不容忍,55%低风险,23%的高风险和13%的未知反应。7%的干预导致没有进一步的行动,更新标签72%,去标签21%。65%的去标签是通过直接去标签和35%的测试剂量攻击。在接受测试剂量挑战的患者中,36/36(97%)没有记录的过敏反应,1/26(3%)出现轻度皮疹。使用氨曲南(预脱标签28%与去标签后1.2%,p<0.001)和美罗培南(13%与2.4%,p=0.022)显着降低,而头孢吡肟(24%vs.50%,p=0.001)和哌拉西林-他唑巴坦(3.7%vs.22%,p<0.001)在去标签后增加。
结论:BLA-P导致21%的去标签,这导致去标签患者中首选Br-ABX的增加和氨曲南/美罗培南的使用减少。
OBJECTIVE: Beta-lactam allergy (BLA) is associated with increased broad-spectrum antibiotic (Br-ABX) use and worse clinical outcomes. We evaluated our hospital-wide BLA protocol (BLA-P) that used following categories: intolerance, low-risk, and high-risk.
METHODS: Hospitalized adult patients with listed BLA during 10/2021-12/2022 were eligible. Exclusions were critically ill, surgical, hospice or comfort care, or non-verbal patients. Assessment was counted each time a pharmacist evaluated BLA. Interventions were no further action (high-risk allergy, patient refusal, unstable clinical status), updated allergy label, or delabeled. Delabeling was done either based on antibiotic history (direct-delabeling), or via test-dose challenge for low-risk patients. Br-ABX usage was compared in the unique delabeled patients: the empiric antibiotic use 90 days post-delabeling versus pre-delabeling using McNemar test (SPSS).
RESULTS: A total of 700 assessments in 631 patients were identified. 441 assessments in 377 patients (median 63 years-old, 41% male, 50% hematological cancer) met inclusion criteria. The assessments revealed 9% intolerance, 55% low-risk, 23% high-risk and 13% unknown reaction. Interventions resulted in no further action 7%, updated label 72%, and delabeling 21%. 65% of the delabeling was via direct-delabeling and 35% test-dose challenge. Among patients who received a test-dose challenge, 36/36(97%) had no documented allergic reactions, and 1/26(3%) developed a mild rash. The use of aztreonam (pre-delabeling 28% vs. post-delabeling 1.2%, p < 0.001) and meropenem (13% vs. 2.4%, p = 0.022) significantly decreased while cefepime (24% vs. 50%, p = 0.001) and piperacillin-tazobactam (3.7% vs. 22%, p < 0.001) increased after delabeling.
CONCLUSIONS: BLA-P led to 21% delabeling, which resulted in increased preferred Br-ABX and decrease in aztreonam/meropenem use among delabeled patients.