scholarly journals Reported β-Lactam and Other Antibiotic Allergies in Solid Organ and Hematopoietic Cell Transplant Recipients

2019 ◽  
Vol 71 (7) ◽  
pp. 1587-1594 ◽  
Author(s):  
Hannah Imlay ◽  
Elizabeth M Krantz ◽  
Erica J Stohs ◽  
Kristine F Lan ◽  
Jacqlynn Zier ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Hematopoietic Cell ◽  
Solid Organ ◽  
Cell Transplant ◽  
Antibiotic Exposure ◽  
Transplant Recipients ◽  
Hematopoietic Cell Transplant ◽  
Antibiotic Allergy ◽  
Days Of Therapy ◽  
Lactam Antibiotic

Abstract Background Patients with reported β-lactam antibiotic allergies (BLAs) are more likely to receive broad-spectrum antibiotics and experience adverse outcomes. Data describing antibiotic allergies among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients are limited. Methods We reviewed records of adult SOT or allogeneic HCT recipients from 1 January 2013 to 31 December 2017 to characterize reported antibiotic allergies at time of transplantation. Inpatient antibiotic use was examined for 100 days posttransplant. Incidence rate ratios (IRRs) comparing antibiotic use in BLA and non-BLA groups were calculated using multivariable negative binomial models for 2 metrics: days of therapy (DOT) per 1000 inpatient days and percentage of antibiotic exposure-days. Results Among 2153 SOT (65%) and HCT (35%) recipients, 634 (29%) reported any antibiotic allergy and 347 (16%) reported BLAs. Inpatient antibiotics were administered to 2020 (94%) patients during the first 100 days posttransplantation; average antibiotic exposure was 41% of inpatient-days (interquartile range, 16.7%–62.5%). BLA patients had significantly higher DOT for vancomycin (IRR, 1.4 [95% confidence interval {CI}, 1.2–1.7]; P < .001), clindamycin (IRR, 7.6 [95% CI, 2.2–32.4]; P = .001), and aztreonam in HCT (IRR, 9.7 [95% CI, 3.3–35.0]; P < .001), and fluoroquinolones in SOT (IRR, 2.9 [95% CI, 2.1–4.0]; P < .001); these findings were consistent when using percentage of antibiotic exposure-days. Conclusions Transplant recipients are frequently exposed to antibiotics and have a high prevalence of reported antibiotic allergies. Reported BLA was associated with greater use of β-lactam antibiotic alternatives. Pretransplant antibiotic allergy evaluation may optimize antibiotic use in this population.

scholarly journals 1001. Feasibility and Outcomes of a Pre-Transplant Antibiotic Allergy Evaluation Program for Allogeneic Hematopoietic Cell Transplant (HCT) Candidates

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S351-S352
Author(s):  
Catherine Liu ◽  
Elizabeth M Krantz ◽  
Erica J Stohs ◽  
Hannah Imlay ◽  
Lahari Rampur ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Hematopoietic Cell ◽  
Antibiotic Prescribing ◽  
Cell Transplant ◽  
Infection Prophylaxis ◽  
Hematopoietic Cell Transplant ◽  
Pneumocystis Jiroveci ◽  
Evaluation Program ◽  
Allogeneic Hct ◽  
Antibiotic Allergy

Abstract Background Antibiotic allergies impact the management of hematopoietic cell transplant (HCT) patients who are often prescribed antibiotics for infection prophylaxis and treatment. We evaluated the feasibility and outcomes of an antibiotic allergy evaluation program prior to allogeneic HCT. Methods In August 2017, we implemented a program to expedite allergy clinic referrals for adult allogeneic HCT candidates who reported an antibiotic allergy at their initial pre-transplant evaluation visit (PTEV). Allergy labels and clinical data including outcomes of allergy evaluation were prospectively collected for patients with PTEVs between 8/10/17 and November 15/18. The use of selected antibiotics was collected in the 100 days following HCT among patients with a reported β-lactam allergy (BLA). Choice of prophylactic agent for Pneumocystis jiroveci among patients with reported sulfa allergies was assessed among HCT recipients after engraftment. Results Of 276 allogeneic HCT candidates, 109 (39.5%) reported >= 1 antibiotic allergy (Table 1). Of the 109, 69 (63%) were referred for allergy evaluation; 83% (57/69) of those referred were evaluated at a median of 14 days after PTEV, and a median of 18 days before transplant. Among evaluated patients, 45 (79%) had >= 1 antibiotic allergy de-labeled including 74% (28/38) of those with BLA (Figure 1). Of the 10 patients whose BLAs could not be delabeled, 1 had a possible immediate IgE-mediated reaction, 5 had a delayed type IV hypersensitivity, and 4 had other reactions or required additional testing. Post-transplant antibiotic use among evaluated vs. nonevaluated patients reporting BLA is shown in Figure 2. Among 31 patients with reported sulfa allergies who underwent HCT, those who were evaluated received TMP-SMX rather than alternative prophylaxis more often (48%; 11/23) than those who were not evaluated (25%; 2/8). 10 (43%) of 23 evaluated patients were delabeled; 7 of 10 delabeled patients received TMP-SMX. Conclusion Antibiotic allergies are frequently reported among HCT candidates. Pre-transplant antibiotic allergy evaluation was feasible, led to de-labeling of the majority of reported allergies, and may alter antibiotic prescribing and increase the use of preferred agents following transplant. Disclosures All authors: No reported disclosures.

scholarly journals Effectiveness of bezlotoxumab for prevention of recurrent Clostridioides difficile infection among transplant recipients

2021 ◽  
Author(s):  
Tanner M Johnson ◽  
Amanda H Howard ◽  
Matthew A Miller ◽  
Lorna L Allen ◽  
Misha Huang ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Standard Of Care ◽  
Hematopoietic Cell ◽  
Solid Organ ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Cell Transplant ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Solid Organ Transplant Recipients

Abstract Background Bezlotoxumab significantly reduces the incidence of recurrent Clostridioides difficile infection; however, limited data is available in solid-organ and hematopoietic-cell transplant recipients. Methods We conducted a single-center retrospective analysis comparing recurrent Clostridioides difficile infection in solid-organ and hematopoietic-cell transplant recipients receiving standard of care alone (oral vancomycin, fidaxomicin, or metronidazole) or bezlotoxumab plus standard of care. The primary outcome was 90-day incidence of recurrent Clostridioides difficile infection, and secondary outcomes included 90-day hospital readmission, mortality, and incidence of heart failure exacerbation. Results Overall, 94 patients received bezlotoxumab plus standard of care (n=38) or standard of care alone (n=56). The mean age was 53 years, patients had a median of 3 prior Clostridioides difficile episodes, and 4 risk factors for recurrent infection. Most patients were solid-organ transplant recipients (76%), with median time to index Clostridioides difficile infection occurring 2.7 years post-transplantation. Ninety-day recurrent Clostridioides difficile infection occurred in 16% (6/38) in the bezlotoxumab cohort compared to 29% (16/56) in the standard of care cohort (p=0.13). Multivariable regression revealed bezlotoxumab was associated with significantly lower odds of 90-day recurrent Clostridioides difficile infection (Odds Ratio [95% CI]: 0.28 [0.08-0.91]). There were no differences in secondary outcomes, and no heart failure exacerbations were observed. Conclusions In a cohort of primarily solid-organ transplant recipients, bezlotoxumab was well tolerated and associated with lower odds of recurrent Clostridioides difficile infection at 90-days. Larger, prospective trials are needed to confirm these findings amongst solid-organ and hematopoietic-cell transplant populations.

scholarly journals Letermovir and its role in the prevention of cytomegalovirus infection in seropositive patients receiving an allogeneic hematopoietic cell transplant

2020 ◽  
Vol 11 ◽  
pp. 204062072093715
Author(s):  
Terri Lynn Shigle ◽  
Victoria Wehr Handy ◽  
Roy F. Chemaly
Keyword(s):  
Organ Transplant ◽  
Primary Prophylaxis ◽  
Lessons Learned ◽  
Hematopoietic Cell ◽  
Solid Organ ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Cmv Reactivation

Cytomegalovirus (CMV) reactivation is one of the most common infections affecting allogeneic hematopoietic cell transplant recipients. Although available anti-CMV therapies have been evaluated for the prevention of CMV reactivation, their toxicity profile makes them unfavorable for use as primary prophylaxis; thus, they are routinely reserved for the treatment of CMV viremia or CMV end-organ disease. Pre-emptive CMV monitoring strategies have been widely accepted, and although they have been helpful in early detection, they have not affected the overall morbidity and mortality associated with CMV. Letermovir is a novel agent that was approved for primary prophylaxis in CMV-seropositive adult allogeneic hematopoietic cell transplant recipients. This review focuses on letermovir’s novel mechanism; clinical trials supporting its United States Food and Drug Administration (FDA) approval and subsequent follow-up analyses; clinical considerations, with an emphasis on pharmacology; and lessons learned from solid organ transplant recipients, as well as potential future directions.

scholarly journals Penicillin Allergy Skin Testing as an Antibiotic Stewardship Intervention in Hematopoietic Cell Transplant Recipients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S266-S267 ◽  
Author(s):  
Christopher Kovacs ◽  
Vasilios Athans ◽  
David Lang ◽  
Ronald Sobecks ◽  
Lisa Rybicki ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Skin Testing ◽  
Hematopoietic Cell ◽  
Penicillin Allergy ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Cell Transplant ◽  
Allergy Skin Testing
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