Advertisement

International Journal of Clinical Pharmacy

, Volume 38, Issue 2, pp 213–217 | Cite as

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

  • Sara M. Swearingen
  • Cyle White
  • Sara Weidert
  • Melisande Hinds
  • John P. Narro
  • Anthony J. GuarascioEmail author
Short Research Report

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 

Notes

Acknowledgments

The authors would like to acknowledge Eric Heidel, Ph.D. for statistical assistance.

Funding

No specific funding was received for this study.

Conflicts of interest

The authors have no conflicts of interest to disclose in regard to this study.

References

  1. 1.
    Lutomski DM, Lafollette JA, Biaglow MA, Haglund LA. Antibiotic allergies in the medical record: effect on drug selection and assessment of validity. Pharmacotherapy. 2008;28(11):1348–53.CrossRefPubMedGoogle Scholar
  2. 2.
    Campagna JD, Bond MC, Schabelman E, et al. The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med. 2012;42(5):612–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol Head Neck Surg. 2007;136(3):340–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Frumin J, Gallagher JC. Allergic cross-sensitivity between penicillin, carbapenem, and monobactam antibiotics: what are the chances? Ann Pharmacother. 2009;43:304–15.PubMedGoogle Scholar
  5. 5.
    Burgmann H, Stoiser B, Heinz G, et al. Likelihood of inadequate treatment: a novel approach to evaluating drug-resistance patterns. Infect Control Hosp Epidemiol. 2009;30:672–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Bantar C, Sartori B, Vesco E, et al. A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis. 2003;37(2):180–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–77.CrossRefPubMedGoogle Scholar
  8. 8.
    Polk RE, Fox C, Mahoney A, et al. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis. 2007;44(5):664–70.CrossRefPubMedGoogle Scholar
  9. 9.
    Sutherland CA, Nicolau DP. Susceptibility profile of ceftolozane/tazobactam and other parenteral antimicrobials against Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa from US hospitals. Clin Ther. 2015;27(7):1564–71.CrossRefGoogle Scholar
  10. 10.
    MacLaughlin EJ, Sasen JJ, Malone DC. Costs of beta lactam allergies. Arch Fam Med. 2000;9:722–6.CrossRefPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2016

Authors and Affiliations

  • Sara M. Swearingen
    • 2
  • Cyle White
    • 3
  • Sara Weidert
    • 4
  • Melisande Hinds
    • 5
  • John P. Narro
    • 6
  • Anthony J. Guarascio
    • 1
    Email author
  1. 1.Duquesne University Mylan School of PharmacyPittsburghUSA
  2. 2.Baxter Regional Medical CenterMountain HomeUSA
  3. 3.Erlanger Health SystemChattanoogaUSA
  4. 4.Ministry St. Joseph’s HospitalMarshfieldUSA
  5. 5.Methodist Charlton Medical CenterDallasUSA
  6. 6.The University of Tennessee Health Science Center Graduate School of Medicine KnoxvilleUSA

Personalised recommendations