Pharmacist-driven penicillin skin testing service for adults prescribed nonpreferred antibiotics in a community hospital

2019 ◽  
Author(s):  
Ethan Englert ◽  
Andrea Weeks
Keyword(s):  
Health System ◽  
Community Hospital ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Hospital Setting ◽  
Primary Objective ◽  
Type I ◽  
Beta Lactam ◽  
Lactam Antibiotic ◽  
Ige Mediated

Abstract Purpose Results of a study evaluating the implementation and impact of a pharmacist-driven penicillin skin testing (PST) service for patients prescribed alternative antibiotics in the community hospital setting are reported. Methods A prospective pilot service in which patients with a documented penicillin allergy (type I, immunoglobulin E [IgE]–mediated) and were prescribed alternative antibiotics received PST by a trained pharmacist was implemented; if test results were negative, the allergy was de-labeled from their electronic medical record. The primary objective was the percentage of patients switched to first-line antibiotics. Secondary objectives included length of stay (LOS) and inpatient antimicrobial costs to the health system. Results Twenty-two patients were proactively identified and received PST by a pharmacist. Of those tested, all were negative, with no type I (IgE-mediated) hypersensitivity reactions to the test itself or to the beta-lactam antibiotic administered thereafter; 68.2% (15/22) were successfully transitioned to a beta-lactam after PST. As a result, a decrease in the use of fluoroquinolones and vancomycin and an increase in use of narrow penicillin-based antibiotics and first- and second-generation cephalosporins were observed. The mean ± S.D. LOS per patient was 7.41 ± 6.1 days, and the total cost of inpatient antimicrobial therapy to the health system was $1,698.88. Conclusion A pharmacist-driven PST service was successfully implemented in a community hospital setting.

scholarly journals 162. Assessment of Beta-lactam Allergies as Rationale for Receipt of Vancomycin for Surgical Prophylaxis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kendall J Tucker ◽  
YoungYoon Ham ◽  
Haley K Holmer ◽  
Caitlin M McCracken ◽  
Ellie Sukerman ◽  
...  
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Skin Testing ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Beta Lactam ◽  
First Line ◽  
Surgical Prophylaxis ◽  
Inappropriate Use ◽  
Oral Amoxicillin ◽  
Ige Mediated

Abstract Background Beta-lactam (BL) antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between classes of BLs, patients with allergies commonly receive vancomycin as an alternative to avoid allergic reaction. The objective of this study was to identify potentially inappropriate use of vancomycin surgical prophylaxis among patients with reported BL allergies. Methods Adult patients (≥18 years) receiving vancomycin for surgical prophylaxis with a reported penicillin and/or cephalosporin allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis. Surgery type and allergy history were extracted from the electronic medical record. Per our institution’s penicillin-testing protocol, patients with IgE-mediated reactions < 10 years ago were eligible for penicillin skin testing (PST), mild reactions or IgE-mediated reaction > 10 years ago were eligible for direct oral amoxicillin challenge, and severe non-IgE mediated allergies were ineligible for penicillin allergy evaluation or BL prophylaxis. Results Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported BL allergy and were included in the analysis (155 with penicillin allergy alone; 21 with cephalosporin allergy; 20 with both cephalosporin and penicillin allergy). Approximately 40% of surgeries were orthopedic. Six patients were ineligible for BL prophylaxis. Per institutional protocol, 73 of 155 patients (48%) may have qualified for PST; 81 of 155 (52%) patients may have received a direct oral amoxicillin challenge. Only 3 of 22 patients with history of methicillin-resistant Staphylococcus aureus appropriately received additional prophylaxis with vancomycin and a BL. Conclusion Patients with BL allergies often qualify for receipt of a first-line BL antibiotic. An opportunity exists for improved BL allergy assessment as an antimicrobial stewardship intervention. Future studies should evaluate outcomes associated with BL allergy evaluation and delabeling in patients receiving surgical prophylaxis. Disclosures All Authors: No reported disclosures

scholarly journals Hispidulin Inhibits Mast Cell-Mediated Allergic Inflammation through Down-Regulation of Histamine Release and Inflammatory Cytokines

Molecules ◽  
2019 ◽  
Vol 24 (11) ◽  
pp. 2131 ◽  
Author(s):  
Dong Eun Kim ◽  
Kyoung-jin Min ◽  
Min-Jong Kim ◽  
Sang-Hyun Kim ◽  
Taeg Kyu Kwon
Keyword(s):  
Mast Cells ◽  
Inflammatory Cytokines ◽  
Immunoglobulin E ◽  
Inflammatory Diseases ◽  
Allergic Inflammation ◽  
Interleukin 4 ◽  
Type I ◽  
Ige Mediated ◽  
Factor Α ◽  
Jnk Activation

Hispidulin (4′,5,7-trihydroxy-6-methoxyflavone) is a natural compound derived from traditional Chinese medicinal herbs, and it is known to have an anti-inflammatory effect. Here, we investigated the effect of hispidulin on the immunoglobulin E (IgE)-mediated allergic responses in rat basophilic leukemia (RBL)-2H3 mast cells. When RBL-2H3 cells were sensitized with anti-dinitrophenyl (anti-DNP) IgE and subsequently stimulated with DNP-human serum albumin (HSA), histamine and β-hexosaminidase were released from the cells by degranulation of activated mast cells. However, pretreatment with hispidulin before the stimulation of DNP-HSA markedly attenuated release of both in anti-DNP IgE-sensitized cells. Furthermore, we investigated whether hispidulin inhibits anti-DNP IgE and DNP-HSA-induced passive cutaneous anaphylaxis (PCA), as an animal model for Type I allergies. Hispidulin markedly decreased the PCA reaction and allergic edema of ears in mice. In addition, activated RBL-2H3 cells induced the expression of inflammatory cytokines (tumor necrosis factor-α and interleukin-4), which are critical for the pathogenesis of allergic disease, through the activation of c-Jun N-terminal kinase (JNK). Inhibition of JNK activation by hispidulin treatment reduced the induction of cytokine expression in the activated mast cells. Our results indicate that hispidulin might be a possible therapeutic candidate for allergic inflammatory diseases through the suppression of degranulation and inflammatory cytokines expression.

scholarly journals The Impact of Penicillin Skin Testing on Aztreonam Stewardship and Cost Savings in Immunocompromised Cancer Patients

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Farnaz Foolad ◽  
Sheila Berlin ◽  
Candice White ◽  
Emma Dishner ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Cost Savings ◽  
Hematologic Malignancies ◽  
Oral Challenge ◽  
Beta Lactam ◽  
History Of ◽  
Antibiotic Cost ◽  
The Impact

Abstract Objective Reported penicillin allergies result in alternative antimicrobial use and are associated with worse outcomes and increased costs. Penicillin skin testing (PST) has recently been shown to be safe and effective in immunocompromised cancer patients, yet its impact on antimicrobial costs and aztreonam utilization has not been evaluated in this population. Method From September 2017 to January 2018, we screened all admitted patients receiving aztreonam. Those with a self-reported history of possible immunoglobulin E (IgE)-mediated reaction to penicillin were eligible for PST with oral challenge. Results A total of 129 patients were screened, and 49 patients were included and underwent testing. Sixteen patients (33%) had hematologic malignancies and 33 patients (67%) had solid tumors. After PST with oral challenge, 46 patients (94%) tested negative, 1 patient tested positive on oral challenge, and 2 patients had indeterminate results. The median time from admission to testing was 2 days (interquartile range, 1–4). After testing negative, 33 patients (72%) were switched to beta-lactam therapy, which resulted in a total of 390 days of beta-lactam therapy. For identical therapy durations, the direct total antibiotic cost was $15 138.89 for beta-lactams versus $78 331.50 for aztreonam, resulting in $63 192.61 in projected savings. A significant reduction in median days of aztreonam therapy per 1000 patient days (10.0 vs 8.0; P = .005) was found during the intervention period. Conclusions Use of PST in immunocompromised cancer patients receiving aztreonam resulted in improved aztreonam stewardship and significant cost savings. Our study demonstrates that PST with oral challenge should be considered in all cancer patients with reported penicillin allergies.

Pharmacy-Led β-Lactam Allergy Interview (BLAI) Reduces Duration of Fluoroquinolones Within a Community Hospital

2019 ◽  
Vol 53 (6) ◽  
pp. 588-595 ◽  
Author(s):  
Elizabeth W. Covington ◽  
Beth Jobson Baldwin ◽  
Emily Warren
Keyword(s):  
Community Hospital ◽  
Skin Testing ◽  
Control Group ◽  
Cohort Design ◽  
Prospective Group ◽  
Before And After ◽  
Effective Option ◽  
Lactam Antibiotic ◽  
Quasi Experimental ◽  
The Impact

Background: Patients with reported β-lactam allergies often receive broad-spectrum antimicrobials and have been shown to experience a variety of negative health consequences, such as increased mortality, costs, readmission, and adverse reactions. Current literature focuses on β-lactam allergy skin testing but lacks evidence on β-lactam allergy interviews (BLAI) when skin testing is unavailable. Objective: This study aimed to test the impact of a pharmacy-led BLAI on duration of fluoroquinolones at a community hospital. Methods: A quasi-experimental design with a prospective cohort design and historical control group was used to assess patients with reported penicillin (PCN) allergies in a community hospital. The primary outcome was duration of fluoroquinolones before and after implementation of BLAI. Secondary outcomes included length of stay (LOS), percentage of patients switched to a β-lactam antibiotic, percentage of antimicrobial stewardship recommendations made/accepted, and discrepancies between allergy in medical record and interview-reported allergy. Nonparametric continuous data and medians were evaluated by Mann-Whitney U. Results: A total of 80 patients were included in the study (43 in the control group and 37 in the prospective group). Fluoroquinolone duration was reduced after the implementation of BLAI (3.7 vs 2.7 days, P = 0.027). In all, 49% of patients in the prospective group were switched to a β-lactam antibiotic after BLAI, with no allergic reactions, adverse effects, or impact on LOS. Conclusion and Relevance: BLAI resulted in a significant reduction in fluoroquinolone duration in patients with PCN allergies and may represent a safe and effective option for institutions lacking skin-testing capabilities.

Description of a pharmacist-managed/administered penicillin allergy skin testing service at a community hospital

2021 ◽  
Author(s):  
Nicholas P Torney ◽  
Michael D Tiberg
Keyword(s):  
Allergic Reaction ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Skin Testing ◽  
Penicillin Allergy ◽  
Type I ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
History Of ◽  
Allergy Skin Testing

Abstract Purpose To describe how a pharmacist-managed and pharmacist-administered penicillin allergy skin testing (PAST) service was incorporated into an antimicrobial stewardship program at a community hospital. Methods A pharmacist-managed/administered PAST service was initiated in October 2015. Patients 18 years of age or older were considered for PAST if they had a reported history of a type I or unknown type of allergic reaction to penicillin that occurred more than 5 years previously. Patients with a vague allergy history were considered for PAST if the provider was uncomfortable prescribing a preferred β-lactam out of concern for penicillin allergy. Patients were excluded if they were pregnant, had a history of a non–type I allergic reaction, or recently received antihistamines. The primary outcome was the percentage of patients who underwent PAST and were subsequently transitioned to a preferred β-lactam. Results PAST was initiated in 90 patients from October 2015 to December 2019. Eighty-five out of 90 patients (94%) completed PAST. Seventy-six out of 90 patients (84.4%) who underwent PAST were transitioned to a preferred β-lactam. The most commonly administered antibiotics prior to PAST were vancomycin, cefepime, and metronidazole. The most commonly used antibiotics after PAST were penicillin, piperacillin/tazobactam, and ampicillin/sulbactam. Among the 90 patients who underwent PAST, alternative antibiotics were avoided for a total of 1,568 days, with a median of 11 days (interquartile range, 6-18 days) avoided per patient. Conclusion Incorporating a pharmacist-managed/administered PAST service into a community hospital’s antimicrobial stewardship program can improve the utilization of preferred antimicrobial therapy and help avoid use of more toxic, costly antimicrobials.

scholarly journals Predominant patterns of β-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Philipp Schrüfer ◽  
Knut Brockow ◽  
Johanna Stoevesandt ◽  
Axel Trautmann
Keyword(s):  
Skin Testing ◽  
Delayed Type Hypersensitivity ◽  
Intradermal Testing ◽  
Reaction Type ◽  
Clinical Reaction ◽  
Additional Information ◽  
Lactam Antibiotic ◽  
Delayed Reactions ◽  
Ige Mediated ◽  
Almost All

Abstract Background Penicillins and other β-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific β-lactams are scarce and inconsistent. We aimed to determine patterns of β-latam allergy, i.e. the association of a clinical reaction type with a specific β-lactam antibiotic. Methods We retrospectively evaluated data from 800 consecutive patients with suspected β-lactam hypersensitivity over a period of 11 years in a single German Allergy Center. Results β-lactam hypersensitivity was definitely excluded in 595 patients, immediate-type (presumably IgE-mediated) hypersensitivity was diagnosed in 70 and delayed-type hypersensitivity in 135 cases. Most (59 out of 70, 84.3%) immediate-type anaphylactic reactions were induced by a limited number of cephalosporins. Delayed reactions were regularly caused by an aminopenicillin (127 out of 135, 94.1%) and usually manifested as a measles-like exanthem (117 out of 135, 86.7%). Intradermal testing proved to be the most useful method for diagnosing β-lactam allergy, but prick testing was already positive in 24 out of 70 patients with immediate-type hypersensitivity (34.3%). Patch testing in addition to intradermal testing did not provide additional information for the diagnosis of delayed-type hypersensitivity. Almost all β-lactam allergic patients tolerated at least one, usually several alternative substances out of the β-lactam group. Conclusions We identified two patterns of β-lactam hypersensitivity: aminopenicillin-induced exanthem and anaphylaxis triggered by certain cephalosporins. Intradermal skin testing was the most useful method to detect both IgE-mediated and delayed-type β-lactam hypersensitivity.

Evaluation of Staphylococcus aureus Bacteremia: Academic and Community-Based Management Within the Same Health System

2017 ◽  
Vol 38 (06) ◽  
pp. 740-742
Author(s):  
Sumaya Ased ◽  
Hamza Rayes ◽  
Jaspreet Dhami ◽  
Nick Amosson ◽  
Akua Fordjour ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Health System ◽  
Community Hospital ◽  
Hospital Setting ◽  
Academic Hospital ◽  
Community Based ◽  
Staphylococcus Aureus Bacteremia ◽  
Retrospective Comparison ◽  
Management Recommendations

A nonrandomized, retrospective comparison of Staphylococcus aureus bacteremia between an academic hospital setting (n=53) and a community hospital setting (n=245) within a single healthcare system was performed. Despite infectious disease consultations, S. aureus bacteremia management recommendations based on Infectious Diseases Society of America (IDSA) guidelines were not followed as closely in the community hospital setting. The community hospital setting requires management standardization for patients with S. aureus bacteremia. Infect Control Hosp Epidemiol 2017;38:740–742

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