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Optimizing preoperative antibiotics in patients with ß-lactam allergies: A role for pharmacy.
Kwiatkowski, Shaina; Mulugeta, Surafel; Davis, Susan; Kenney, Rachel; Kalus, James; Walton, Leslie; Patel, Nisha.
  • Kwiatkowski S; Department of Pharmacy Services, Henry Ford Macomb Hospital, Clinton Township, MI, USA.
  • Mulugeta S; Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
  • Davis S; Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
  • Kenney R; Department of Pharmacy Practice, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, MI, USA.
  • Kalus J; Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
  • Walton L; Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
  • Patel N; Department of Anesthesiology, Mednax, Warren, MI, USA.
Am J Health Syst Pharm ; 78(Supplement_3): S76-S82, 2021 Aug 30.
Article in English | MEDLINE | ID: covidwho-1243455
Semantic information from SemMedBD (by NLM)
1. Antibiotics TREATS Hypersensitivity
Subject
Antibiotics
Predicate
TREATS
Object
Hypersensitivity
2. Antibiotics TREATS Patients
Subject
Antibiotics
Predicate
TREATS
Object
Patients
3. Hypersensitivity PROCESS_OF Patients
Subject
Hypersensitivity
Predicate
PROCESS_OF
Object
Patients
4. Antibiotic Prophylaxis ADMINISTERED_TO Patients
Subject
Antibiotic Prophylaxis
Predicate
ADMINISTERED_TO
Object
Patients
5. Operative Surgical Procedures TREATS Patients
Subject
Operative Surgical Procedures
Predicate
TREATS
Object
Patients
6. Neurosurgical Procedures TREATS Patients
Subject
Neurosurgical Procedures
Predicate
TREATS
Object
Patients
7. Allergy testing USES beta-Lactams
Subject
Allergy testing
Predicate
USES
Object
beta-Lactams
8. Antibiotics AFFECTS Surgical Wound Infection
Subject
Antibiotics
Predicate
AFFECTS
Object
Surgical Wound Infection
9. Antibiotics TREATS Hypersensitivity
Subject
Antibiotics
Predicate
TREATS
Object
Hypersensitivity
10. Antibiotics TREATS Patients
Subject
Antibiotics
Predicate
TREATS
Object
Patients
11. Hypersensitivity PROCESS_OF Patients
Subject
Hypersensitivity
Predicate
PROCESS_OF
Object
Patients
12. Antibiotic Prophylaxis ADMINISTERED_TO Patients
Subject
Antibiotic Prophylaxis
Predicate
ADMINISTERED_TO
Object
Patients
13. Operative Surgical Procedures TREATS Patients
Subject
Operative Surgical Procedures
Predicate
TREATS
Object
Patients
14. Neurosurgical Procedures TREATS Patients
Subject
Neurosurgical Procedures
Predicate
TREATS
Object
Patients
15. Allergy testing USES beta-Lactams
Subject
Allergy testing
Predicate
USES
Object
beta-Lactams
16. Antibiotics AFFECTS Surgical Wound Infection
Subject
Antibiotics
Predicate
AFFECTS
Object
Surgical Wound Infection
ABSTRACT

PURPOSE:

Patients with a reported ß-lactam allergy (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSIs), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview service in the preoperative setting.

METHODS:

A pharmacist performed BLA clarification telephone interviews before elective procedures from November 2018 to March 2019. On the basis of allergy history and a decision algorithm, first-line preoperative antibiotics, alternative antibiotics, or allergy testing referral was recommended. The pharmacist intervention (PI) group was compared to a standard of care (SOC) group who underwent surgery from November 2017 to March 2018.

RESULTS:

Eighty-seven patients were included, with 50 (57%) and 37 (43%) in the SOC and PI groups, respectively. The most common surgeries included orthopedic surgery in 41 patients (47%) and neurosurgery in 17 patients (20%). In the PI group, all BLA labels were updated after interview. Twenty-three patients were referred for allergy testing, 12 of the 23 (52%) completed BLA testing, and penicillin allergies were removed for 9 of the 12 patients. Overall, 28 of the 37 (76%) pharmacy antibiotic recommendations were accepted. Cefazolin use significantly increased from 28% to 65% after the intervention (P = 0.001). SSI occurred in 5 (10%) patients in the SOC group and no patients in the PI group (P = 0.051). All of these SSIs were associated with alternative antibiotics. Incidence of AKI and CDI was similar between the groups. No allergic reactions occurred in either group.

CONCLUSION:

Implementation of a pharmacy-driven BLA reconciliation significantly increased ß-lactam preoperative use without negative safety outcomes.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pharmacy / Drug Hypersensitivity Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Am J Health Syst Pharm Journal subject: Pharmacy / Hospitals Year: 2021 Document Type: Article Affiliation country: Ajhp

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pharmacy / Drug Hypersensitivity Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Am J Health Syst Pharm Journal subject: Pharmacy / Hospitals Year: 2021 Document Type: Article Affiliation country: Ajhp