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2271. Suppressing the Penicillin-Cephalosporin Allergy Cross-Reactivity Alert: Safety and Impact on Cephalosporin Prescribing

BACKGROUND: Beta-lactam antibiotics are the preferred therapy for many infections. Alternative or broad-spectrum antibiotics are often prescribed to patients with documented penicillin allergies, which can lead to increased rates of mortality, hospital-acquired infections, antimicrobial resistance,...

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Autores principales: Russell, Lauren, Krekel, Tamara, Neuner, Elizabeth, Ritchie, David J, Newland, Helen, Owen, Emily J, Bewley, Alice, Durkin, Michael J, Hsueh, Kevin, Monroy, Jennifer, Bohn, Brian C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677296/
http://dx.doi.org/10.1093/ofid/ofad500.1893
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author Russell, Lauren
Krekel, Tamara
Neuner, Elizabeth
Ritchie, David J
Newland, Helen
Owen, Emily J
Bewley, Alice
Durkin, Michael J
Hsueh, Kevin
Monroy, Jennifer
Bohn, Brian C
author_facet Russell, Lauren
Krekel, Tamara
Neuner, Elizabeth
Ritchie, David J
Newland, Helen
Owen, Emily J
Bewley, Alice
Durkin, Michael J
Hsueh, Kevin
Monroy, Jennifer
Bohn, Brian C
author_sort Russell, Lauren
collection PubMed
description BACKGROUND: Beta-lactam antibiotics are the preferred therapy for many infections. Alternative or broad-spectrum antibiotics are often prescribed to patients with documented penicillin allergies, which can lead to increased rates of mortality, hospital-acquired infections, antimicrobial resistance, surgical site infections, hospital length of stay, and cost of care. In March 2021, BJC health-system modified and suppressed the penicillin-cephalosporin allergy cross-reactivity alert for non-serious allergic reactions and implemented an alert prompting clarification of documented penicillin allergies without specific reactions documented. METHODS: This quasi-experimental, retrospective study includes patients with a documented penicillin allergy and a systemic antibiotic order prescribed for outpatient encounters or administered for inpatient encounters from March 2019-February 2020 (pre-intervention) or March 2021-February 2022 (post-intervention) at Barnes-Jewish Hospital or St. Louis Children’s Hospital. Patients with a baseline documented cephalosporin or carbapenem allergy were excluded. Descriptive statistics, chi-squared, or Mann-Whitney U tests were utilized as appropriate. The primary outcome was cephalosporin use and the main secondary outcome was allergic reaction to the cephalosporin ordered or administered. RESULTS: The pre and post-intervention groups consisted of 7,765 and 7,361 encounters with 25,141 and 24,142 systemic antibiotic orders, respectively. Cephalosporin prescribing was increased post alert suppression by 5.5% (27.7% pre-intervention vs. 33.2% post-intervention, p< 0.001) (Table 1). Allergic reactions after cephalosporin use were not increased post-intervention (Table 2). Out of 1,324 alerts to improve allergy documentation in patients with an “other” or “unknown” penicillin allergy, 4.2% resulted in penicillin allergy documentation updates (Table 3). [Figure: see text] Cephalosporin use was increased post alert suppression by 5.5%, p<0.001. Use of many alternative antibiotics, including vancomycin, fluoroquinolones, macrolides, clindamycin, aztreonam decreased in the post-intervention; however, use of carbapenems, tetracyclines and vancomycin resistant Enterococcus agents increased. [Figure: see text] Allergic reactions to the ordered or administered cephalosporin, as identified by addition of a new allergy within 30 days to the electronic medical record, was similar between pre-intervention and post-intervention groups. Only 5/14,999 (0.03%) and 59/14,999 (0.4%) cephalosporin orders were associated with serious and non-serious allergies, respectively. Fewer orders in the post-intervention group were associated with updates to penicillin allergy documentation; however, more orders were associated with removal of penicillin allergies in the post-intervention group, p<0.001. [Figure: see text] The BestPractice Advisory (BPA) alert appeared for prescribers when ordering a cephalosporin, carbapenem, or penicillin group antibiotic in a patient with a documented “unknown” or “other” penicillin allergy to improve allergy documentation. From this alert, the prescriber can keep or remove the order or select a hyperlink to update the penicillin allergy. If the order was kept, the prescriber had to select an override reason. The penicillin allergy was updated during hospitalization for 55 inpatient alerts and within 30 days for 1 outpatient alert. CONCLUSION: The results of this study indicate that the suppression of penicillin-cephalosporin cross allergy alerts is safe and effective in increasing cephalosporin prescribing without increased allergic reactions. Other institutions may consider an alert to improve unclear allergy documentation. DISCLOSURES: Tamara Krekel, PharmD, BCPS, BCIDP, AbbVie: Honoraria|Merck: Honoraria|Shionogi: Honoraria David J. Ritchie, PharmD, BCPS (AQ-ID), Abbvie: Honoraria|Shionogi: Honoraria Emily J. Owen, PharmD, MS, BCPS, BCCCP, Mallinckrodt: Advisor/Consultant|Mallinckrodt: Speaker's Bureau Brian C. Bohn, PharmD, BCIDP, T2 Biosystems, Inc.: Currently employed as a Medical Science Liaison by T2 Biosystems, Inc.
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spelling pubmed-106772962023-11-27 2271. Suppressing the Penicillin-Cephalosporin Allergy Cross-Reactivity Alert: Safety and Impact on Cephalosporin Prescribing Russell, Lauren Krekel, Tamara Neuner, Elizabeth Ritchie, David J Newland, Helen Owen, Emily J Bewley, Alice Durkin, Michael J Hsueh, Kevin Monroy, Jennifer Bohn, Brian C Open Forum Infect Dis Abstract BACKGROUND: Beta-lactam antibiotics are the preferred therapy for many infections. Alternative or broad-spectrum antibiotics are often prescribed to patients with documented penicillin allergies, which can lead to increased rates of mortality, hospital-acquired infections, antimicrobial resistance, surgical site infections, hospital length of stay, and cost of care. In March 2021, BJC health-system modified and suppressed the penicillin-cephalosporin allergy cross-reactivity alert for non-serious allergic reactions and implemented an alert prompting clarification of documented penicillin allergies without specific reactions documented. METHODS: This quasi-experimental, retrospective study includes patients with a documented penicillin allergy and a systemic antibiotic order prescribed for outpatient encounters or administered for inpatient encounters from March 2019-February 2020 (pre-intervention) or March 2021-February 2022 (post-intervention) at Barnes-Jewish Hospital or St. Louis Children’s Hospital. Patients with a baseline documented cephalosporin or carbapenem allergy were excluded. Descriptive statistics, chi-squared, or Mann-Whitney U tests were utilized as appropriate. The primary outcome was cephalosporin use and the main secondary outcome was allergic reaction to the cephalosporin ordered or administered. RESULTS: The pre and post-intervention groups consisted of 7,765 and 7,361 encounters with 25,141 and 24,142 systemic antibiotic orders, respectively. Cephalosporin prescribing was increased post alert suppression by 5.5% (27.7% pre-intervention vs. 33.2% post-intervention, p< 0.001) (Table 1). Allergic reactions after cephalosporin use were not increased post-intervention (Table 2). Out of 1,324 alerts to improve allergy documentation in patients with an “other” or “unknown” penicillin allergy, 4.2% resulted in penicillin allergy documentation updates (Table 3). [Figure: see text] Cephalosporin use was increased post alert suppression by 5.5%, p<0.001. Use of many alternative antibiotics, including vancomycin, fluoroquinolones, macrolides, clindamycin, aztreonam decreased in the post-intervention; however, use of carbapenems, tetracyclines and vancomycin resistant Enterococcus agents increased. [Figure: see text] Allergic reactions to the ordered or administered cephalosporin, as identified by addition of a new allergy within 30 days to the electronic medical record, was similar between pre-intervention and post-intervention groups. Only 5/14,999 (0.03%) and 59/14,999 (0.4%) cephalosporin orders were associated with serious and non-serious allergies, respectively. Fewer orders in the post-intervention group were associated with updates to penicillin allergy documentation; however, more orders were associated with removal of penicillin allergies in the post-intervention group, p<0.001. [Figure: see text] The BestPractice Advisory (BPA) alert appeared for prescribers when ordering a cephalosporin, carbapenem, or penicillin group antibiotic in a patient with a documented “unknown” or “other” penicillin allergy to improve allergy documentation. From this alert, the prescriber can keep or remove the order or select a hyperlink to update the penicillin allergy. If the order was kept, the prescriber had to select an override reason. The penicillin allergy was updated during hospitalization for 55 inpatient alerts and within 30 days for 1 outpatient alert. CONCLUSION: The results of this study indicate that the suppression of penicillin-cephalosporin cross allergy alerts is safe and effective in increasing cephalosporin prescribing without increased allergic reactions. Other institutions may consider an alert to improve unclear allergy documentation. DISCLOSURES: Tamara Krekel, PharmD, BCPS, BCIDP, AbbVie: Honoraria|Merck: Honoraria|Shionogi: Honoraria David J. Ritchie, PharmD, BCPS (AQ-ID), Abbvie: Honoraria|Shionogi: Honoraria Emily J. Owen, PharmD, MS, BCPS, BCCCP, Mallinckrodt: Advisor/Consultant|Mallinckrodt: Speaker's Bureau Brian C. Bohn, PharmD, BCIDP, T2 Biosystems, Inc.: Currently employed as a Medical Science Liaison by T2 Biosystems, Inc. Oxford University Press 2023-11-27 /pmc/articles/PMC10677296/ http://dx.doi.org/10.1093/ofid/ofad500.1893 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Russell, Lauren
Krekel, Tamara
Neuner, Elizabeth
Ritchie, David J
Newland, Helen
Owen, Emily J
Bewley, Alice
Durkin, Michael J
Hsueh, Kevin
Monroy, Jennifer
Bohn, Brian C
2271. Suppressing the Penicillin-Cephalosporin Allergy Cross-Reactivity Alert: Safety and Impact on Cephalosporin Prescribing
title 2271. Suppressing the Penicillin-Cephalosporin Allergy Cross-Reactivity Alert: Safety and Impact on Cephalosporin Prescribing
title_full 2271. Suppressing the Penicillin-Cephalosporin Allergy Cross-Reactivity Alert: Safety and Impact on Cephalosporin Prescribing
title_fullStr 2271. Suppressing the Penicillin-Cephalosporin Allergy Cross-Reactivity Alert: Safety and Impact on Cephalosporin Prescribing
title_full_unstemmed 2271. Suppressing the Penicillin-Cephalosporin Allergy Cross-Reactivity Alert: Safety and Impact on Cephalosporin Prescribing
title_short 2271. Suppressing the Penicillin-Cephalosporin Allergy Cross-Reactivity Alert: Safety and Impact on Cephalosporin Prescribing
title_sort 2271. suppressing the penicillin-cephalosporin allergy cross-reactivity alert: safety and impact on cephalosporin prescribing
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677296/
http://dx.doi.org/10.1093/ofid/ofad500.1893
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