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Int J Clin Pharm. 2016 Apr;38(2):213-7. doi: 10.1007/s11096-016-0248-y. Epub 2016 Jan 14.

A multidimensional antimicrobial stewardship intervention targeting aztreonam use in patients with a reported penicillin allergy.

Author information

1
Baxter Regional Medical Center, Mountain Home, AR, USA.
2
Erlanger Health System, Chattanooga, TN, USA.
3
Ministry St. Joseph's Hospital, Marshfield, WI, USA.
4
Methodist Charlton Medical Center, Dallas, TX, USA.
5
The University of Tennessee Health Science Center Graduate School of Medicine, Knoxville, TN, USA.
6
Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA. guarascioa@duq.edu.

Abstract

BACKGROUND:

Local antimicrobial susceptibility patterns should be considered for antimicrobial therapy decisions. Antibiogram data can guide beta-lactam antibiotic use in the presence of a penicillin allergy, particularly when allergic cross-reactivity among antibiotic agents is unlikely.

OBJECTIVE:

To evaluate the effect of a multidimensional antimicrobial stewardship intervention to improve antibiogram-driven antibiotic selection for patients with a reported penicillin allergy receiving aztreonam.

METHODS:

This historically controlled, quasi-experimental study compared historical aztreonam use with prospective antibiotic selection following a pharmacist-led intervention in patients with a penicillin allergy. The impact of this intervention on aztreonam use, antimicrobial selection, patient allergy profile updates, length of stay, in-hospital mortality, and antibiotic cost savings was assessed.

RESULTS:

A significant reduction in median days of aztreonam therapy (4.0 vs. 2.0; p = 0.0001) and median days of therapy per 1000 patient days (14.5 vs. 9.3; p = 0.0001) was found in the intervention group.

CONCLUSION:

A pharmacist-led antimicrobial stewardship intervention facilitated antibiogram-driven antibiotic therapy while reducing aztreonam use in patients without an anaphylactic penicillin allergy. Further trials are needed to assess the utility of similar antimicrobial stewardship interventions for patients with penicillin allergy.

KEYWORDS:

Antibiogram; Antibiotic resistance; Antimicrobial stewardship; Beta-lactam antibiotics; Drug allergy; Infectious diseases; Medical education

PMID:
26768137
DOI:
10.1007/s11096-016-0248-y
[Indexed for MEDLINE]

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