Impact of an Antibiotic Side-Chain-Based Cross-reactivity Chart Combined With Enhanced Allergy Assessment Processes for Surgical Prophylaxis Antimicrobials in Patients With ß-Lactam Allergies.
Clin Infect Dis
; 72(8): 1404-1412, 2021 04 26.
Article
en En
| MEDLINE
| ID: mdl-32155264
ABSTRACT
BACKGROUND:
ß-Lactam antibiotics are first-line therapy for perioperative prophylaxis; however, patient-reported allergies often lead to increased prescribing of alternative antibiotics that may increase the incidence of surgical site infections. The R-group side chain of the ß-lactam ring is responsible for allergic cross-reactivity and experts recommend the use of ß-lactams that are structurally dissimilar.METHODS:
An internally developed, antibiotic side-chain-based cross-reactivity chart was developed and implemented alongside enhanced allergy assessment processes. This single-center, quasi-experimental study analyzed antibiotic prescribing in all adult patients with a documented ß-lactam allergy undergoing an inpatient surgical procedure between quartile (Q) 1 (2012)-Q3 (2014) (historical group) and Q3 (2016)-Q3 (2018) (intervention group). Propensity-weighted scoring analyses compared categorical and continuous outcomes. Interrupted time-series analysis further analyzed key outcomes.RESULTS:
A total of 1119 and 1089 patients were included in the historical and intervention cohorts, respectively. There was a significant difference in patients receiving a ß-lactam alternative antibiotic between cohorts (84.9% vs 15.1%; Pâ <â .001). There was a decrease in 30-day readmissions in the intervention cohort (7.9% vs 6.3%; Pâ =â .035); however, there was no difference in the incidence of SSIs in patients readmitted (14.8% vs 13%; Pâ =â .765). No significant differences were observed in allergic reactions (0.5% vs 0.3%; Pâ =â .323), surgical site infections, in-hospital and 30-day mortality, healthcare facility-onset Clostridiodes difficile infection, acute kidney injury, or hospital costs.CONCLUSIONS:
Implementation of an antibiotic cross-reactivity chart combined with enhanced allergy assessment processes significantly improved the prescribing of ß-lactam antibiotics for surgical prophylaxis.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Hipersensibilidad a las Drogas
/
Antiinfecciosos
Límite:
Adult
/
Humans
Idioma:
En
Año:
2021
Tipo del documento:
Article