住院患者过敏指南对β-内酰胺类药物和替代抗生素使用的影响。
Impact of an Inpatient Allergy Guideline on β-Lactam and Alternative Antibiotic Use.
机构信息
Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California San Francisco, San Francisco, Calif.
Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California San Francisco, San Francisco, Calif.
出版信息
J Allergy Clin Immunol Pract. 2023 Aug;11(8):2557-2567.e6. doi: 10.1016/j.jaip.2023.04.051. Epub 2023 May 12.
BACKGROUND
A guideline identifying when inpatients with penicillin or cephalosporin antibiotic allergy labels (PCAAL) can receive β-lactam antibiotics increased β-lactam receipt at a large northeastern US health care system.
OBJECTIVE
To report outcomes of implementing a similar guideline and electronic order set (OS) at an independent academic health care system.
METHODS
Penicillin/cephalosporin receipt (percentage of inpatients receiving full doses) and alternative antibiotic use (days of therapy per 1000 patient-days [DOT/1000PD]) were compared over 3 periods before (February 1, 2017, to January 31, 2018) and after guideline implementation (February 1, 2018, to January 31, 2019), and after OS implementation (February 1, 2019, to January 31, 2020) among inpatients with PCAAL admitted on medical services with access to guideline/OS and education (Medical-PCAAL, n = 8721), surgical services with access to guideline/OS without education (Surgical-PCAAL, n = 5069), and obstetrics/gynecology services without interventions (Ob/Gyn-PCAAL, n = 798) and inpatients without PCAAL admitted on the same services (Medical-No-PCAAL, n = 50,840; Surgical-No-PCAAL, n = 29,845; Ob/Gyn-No-PCAAL, n = 6109). χ tests were used to compare categorical variables, and analysis of variance was used to compare continuous and interrupted time series analyses (ITSA) to investigate the guideline/OS implementation effect on penicillin/cephalosporin receipt.
RESULTS
In the Medical-PCAAL group, penicillin/cephalosporin receipt increased (58%-68%, P < .001), specifically for cefazolin (8%-11%, P = .02) and third- to fifth-generation cephalosporins (43%-48%, P = .04), and aztreonam use decreased (12 DOT/1000PD, P = .03). In the Medical-No-PCAAL group, penicillin/cephalosporin receipt increased (88%-90%, P = .004), specifically for penicillin (40%-44%, P < .001), without changes in aztreonam use. Significant changes were not observed in these outcomes on surgical or obstetrics/gynecology services. Per ITSA, guideline/OS implementation was associated with increased penicillin/cephalosporin receipt in the Medical-PCAAL group only.
CONCLUSION
Guideline and OS implementation was associated with improved antibiotic stewardship on inpatient services that also received allergy education.
背景
一份确定有青霉素或头孢菌素类抗生素过敏标签（PCAAL）的住院患者何时可以使用β-内酰胺类抗生素的指南，增加了美国东北部一家大型医疗保健系统中β-内酰胺类抗生素的使用。
目的
报告在一个独立的学术医疗保健系统中实施类似指南和电子医嘱集（OS）的结果。
方法
在有 PCAAL 标签的住院患者中，比较了实施指南前（2017 年 2 月 1 日至 2018 年 1 月 31 日）、实施指南后（2018 年 2 月 1 日至 2019 年 1 月 31 日）和实施 OS 后（2019 年 2 月 1 日至 2020 年 1 月 31 日）三个时期内，使用β-内酰胺类抗生素的情况（接受全剂量的住院患者比例）和替代抗生素的使用情况（每 1000 个患者天的治疗天数 [DOT/1000PD]）。在有 PCAAL 标签的内科患者中（有机会使用指南/OS 和接受教育的 Medical-PCAAL，n=8721）、外科患者中（有机会使用指南/OS 但无教育的 Surgical-PCAAL，n=5069）和妇产科患者中（无干预措施的 Ob/Gyn-PCAAL，n=798），以及无 PCAAL 标签的内科患者中（有机会使用相同服务的 Medical-No-PCAAL，n=50840；无机会使用相同服务的 Surgical-No-PCAAL，n=29845；无机会使用相同服务的 Ob/Gyn-No-PCAAL，n=6109），使用卡方检验比较分类变量，使用方差分析比较连续和中断时间序列分析（ITSA），以调查指南/OS 实施对青霉素/头孢菌素类抗生素使用的影响。
结果
在内科的 PCAAL 组中，青霉素/头孢菌素类抗生素的使用率增加（58%-68%，P<0.001），特别是头孢唑林（8%-11%，P=0.02）和三至五代头孢菌素（43%-48%，P=0.04），而氨曲南的使用减少（12DOT/1000PD，P=0.03）。在内科的 No-PCAAL 组中，青霉素/头孢菌素类抗生素的使用率增加（88%-90%，P=0.004），特别是青霉素（40%-44%，P<0.001），而氨曲南的使用没有变化。在外科或妇产科服务中，这些结果没有观察到显著变化。根据 ITSA，仅在 Medical-PCAAL 组中，指南/OS 的实施与青霉素/头孢菌素类抗生素的使用率增加相关。
结论
在接受过敏教育的住院服务中实施指南和 OS 与改善抗生素管理有关。
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