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.

Review of Pharmacist Driven Penicillin Allergy Assessments and Skin Testing: A Multi-Center Case-Series

2021 ◽  
pp. 001857872110468
Author(s):  
Hanna M. Harper ◽  
Michael Sanchez
Keyword(s):  
Skin Testing ◽  
Case Series ◽  
Cost Savings ◽  
Penicillin Allergy ◽  
Teaching Hospitals ◽  
Beta Lactam ◽  
Retrospective Case ◽  
Beta Lactam Antibiotics ◽  
Case Series Study ◽  
The Impact

Objective: To describe the impact of pharmacy driven penicillin allergy assessments on de-labeling penicillin allergies and antibiotic streamlining opportunities for hospitalized patients. Design: Multi-center, retrospective case-series study. Setting: A health system of 4 non-teaching hospitals. Participants: Patients aged 18 years and older with a physician order for a pharmacist penicillin allergy assessment. Exclusion criteria consisted of patients with anaphylaxis or a type II penicillin allergy, anaphylaxis of any cause within 4 weeks, refusal of penicillin allergy skin test (PAST), antihistamine use within 24 hours, penicillin intolerance, immunosuppression or immunosuppressive medications, or skin conditions that could interfere with PAST. Interventions: The primary endpoint evaluated the number of de-labeled penicillin allergies after pharmacists provided penicillin allergy assessments. Secondary endpoints evaluated the percent of patients with antibiotics deescalated to beta-lactam antibiotics and classification of notable interventions made by pharmacists. Measurements and Main Results: There were 35 patients who met inclusion criteria. Twenty-four patients underwent both penicillin allergy skin testing and oral (PO) amoxicillin challenge. Five patients had allergies de-labeled only after a pharmacist interview. Four patients received only the PO amoxicillin challenge and 2 patients received only PAST. Penicillin allergies were de-labeled from the electronic health record (EHR) in 31 (89%) patients despite all testing negative for a penicillin allergy from PAST or a PO amoxicillin challenge. Four patients had the allergy re-added to the chart on subsequent admissions. No patients experienced a reaction from PAST, PO amoxicillin challenge, or subsequent beta-lactam antibiotics. Twenty-eight (80%) patients had their antibiotic therapy changed as a result of the allergy assessment. Seventeen patients were de-escalated onto beta-lactam antibiotics and aztreonam was stopped in 6 patients. Conclusion: Results from this study suggests that pharmacists expanding their scope of practice with PAST is a safe and effective allergy de-labeling tool. Pharmacist-driven penicillin allergy assessments could provide antibiotic cost savings and avoid aztreonam use. The study supports the need to emphasize education for patients and caretakers regarding allergy testing results to avoid relabeling in future hospital visits.

scholarly journals The impact of food matrices on egg allergenicity

2021 ◽  
Author(s):  
Kelsey Kaman ◽  
Stephanie Leeds
Keyword(s):  
Clinical Decision Making ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Peanut Butter ◽  
Clinical Decision ◽  
Oral Challenge ◽  
Rapid Improvement ◽  
Prolonged Heating ◽  
Food Matrices ◽  
The Impact

Background: Although many studies show the impact of high and prolonged heating on allergenicity, scarce research exists that examined the impact of the food matrix effect. We presented a case that demonstrates the need for further investigation into this field.Case: An 8-month-old breast-fed girl with a history of moderate eczema presented with concern for food allergy. At 7 months old, she seemed to have difficulty with nursing after consumption of peanut butter, and her pediatrician recommended further avoidance. On presentation to allergy, she had not yet consumed eggs; therefore, skin testing was obtained for both peanut and egg. Her skin testing result to peanut was negative, whereas to egg was elevated at 5/20 mm. To further support clinical decision-making, blood work was obtained, and the egg white specific immunoglobulin E (IgE) value was elevated to 1.33 kU/L. It was recommended to the family to pursue home introduction of peanut and return for oral challenge to baked egg. At 14 months old, the patient returned for oral challenge and successfully tolerated one-half of a muffin. She was discharged with instructions to continue consumption of one-half of a muffin ideally three or more times a week, which the parents reported she continued to tolerate.Conclusion: When the patient was 24 months old, the mother decided, without consultation, to introduce banana-chocolatechip muffins. With the first two ingestions, she developed immediate urticaria. On the third consumption, she developed anaphylaxis, which required epinephrine, with rapid improvement. The patient subsequently returned to regular consumption ofstandard egg muffins (as well as bananas and chocolate individually), which she continued to tolerate. Based on our patient’s ability to tolerate baked egg muffins without banana but significant reaction to baked egg muffins with banana, a potential explanation is that the addition of banana disrupted the egg-wheat matrix. This report points toward a continued need to investigate the role food matrices play on the allergenicity of foods. Furthermore, this case demonstrated the importance of adhering to allergist-prescribed recipes to prevent allergic reactions.

scholarly journals Changes in Intravenous Immunoglobulin Usage for Hypogammaglobulinemia After Implementation of a Stewardship Program

2020 ◽  
pp. OP.20.00312
Author(s):  
Benjamin A. Derman ◽  
Zachary Schlei ◽  
Sandeep Parsad ◽  
Kathleen Mullane ◽  
Randall W. Knoebel
Keyword(s):  
Intravenous Immunoglobulin ◽  
Cost Savings ◽  
Hematologic Malignancies ◽  
Hospitalization Rate ◽  
T Cell Therapy ◽  
Stewardship Program ◽  
Car T ◽  
History Of ◽  
Igg Level ◽  
Ivig Administration

PURPOSE: Intravenous immunoglobulin (IVIG) is used to replenish immunoglobulins in hypogammaglobulinemia (HG) caused by hematologic malignancies (HM) or their treatment (autologous stem-cell transplantation [ASCT] and chimeric antigen receptor T-cell therapy [CAR-T]), in an effort to reduce the risk of infections. However, there is limited evidence to support this use, and IVIG supplies are limited and shortages are common. METHODS: An IVIG stewardship program (ISP) was implemented with the following requirements for IVIG administration: immunoglobulin G (IgG) level < 400 mg/dL (corrected for paraprotein) for post-ASCT and post–CAR-T patients, or IgG < 400 mg/dL with a history of a bacterial infection within the preceding 3 months for those with HM. Comparisons of the amount of IVIG administered, the incidence of infections, and the use of antimicrobials were performed between the 3 months before ISP and the 3 months after ISP. RESULTS: IVIG administered for HG decreased from 4,902 g in 86 patients before ISP to 1,777 g in 55 patients after ISP, a cost savings of $44,700. Adherence to ISP guidelines was 80%. Compared with before ISP, patients who stopped receiving IVIG after ISP had lower nadir IgG, fewer infections/patient-months, less antimicrobial usage, and a lower hospitalization rate for infection; no deaths occurred. Compared with before ISP, patients receiving IVIG after ISP had lower predose IgG and fewer infections/patient-months; the antibiotic usage, hospitalization rate for infection, and deaths from infection remained stable. CONCLUSION: To our knowledge, this is the first ISP to lead to a dramatic decrease in IVIG usage with high adherence, primarily by selecting out patients at low risk of infection after IVIG discontinuation. Such an ISP is replicable and warrants adoption.

Outcomes for hospitalized cancer patients with COVID-19 during the height of pandemic in New York City.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10572-10572
Author(s):  
Amelia Sawyers ◽  
Margaret Chou ◽  
Paul Johannet ◽  
Nicholas Gulati ◽  
Yingzhi Qian ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Cancer Patients ◽  
York City ◽  
Measurable Disease ◽  
All Cause Mortality ◽  
History Of ◽  
The Impact ◽  
History Of Cancer ◽  
Active Cancer

10572 Background: Several reports have suggested that cancer patients are at increased risk for contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and suffering worse coronavirus disease 2019 (COVID-19) outcomes. However, little is known about the impact of cancer status on presentation and outcome. Here, we report on the association between cancer status and survival in hospitalized patients who tested positive for SARS-CoV-2 during the height of pandemic in New York City. Methods: Of the 6,724 patients who were hospitalized at NYU Langone Health (3/16/20 - 7/31/20) and tested positive for SARS-CoV-2, 580 had either active cancer (n = 221) or a history of cancer (n = 359). Patients were classified as having active malignancy if they either received treatment within six months of their COVID-19 diagnosis or they had measurable disease documented at the time of their hospitalization. Patients were categorized as having a history of cancer if there was no evidence of measurable disease or there were no treatments administered within six months of their COVID-19 diagnosis. We compared the baseline clinicodemographic characteristics and hospital courses of the two groups, and the relationship between cancer status and the rate of admission to the intensive care unit (ICU), use of invasive mechanical ventilation (IMV), and all-cause mortality. Results: There was no differences between the two groups in their baseline laboratory results associated with COVID-19 infection, incidence of venous thromboembolism, or incidence of severe COVID-19. Active cancer status was not associated with the rate of ICU admission ( P = 0.307) or use of IMV ( P = 0.236), but was significantly associated with worse all-cause mortality in both univariate and multivariate analysis with ORs of 1.48 (95% CI: 1.04-2.09; P = 0.028) and 1.71 (95% CI: 1.12-2.63; P = 0.014), respectively. Conclusions: Active cancer patients had worse survival outcomes compared to patients with a history of cancer despite similar COVID-19 disease characteristics in the two groups. Our data suggest that cancer care should continue with minimal interruptions during the pandemic to bring about response and remission as soon as possible. Additionally, these findings support the growing body of evidence that malignancy portends worse COVID-19 prognosis, and demonstrate that the risk may even apply to those without active disease.

scholarly journals 2717. The Impact of Pneumococcal Conjugate Vaccine in Nonbacteremic Pneumococcal Pneumonia Among Cancer Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S956-S956
Author(s):  
Yeon Joo Lee ◽  
Rocco Richards ◽  
Yiqi Su ◽  
Anna Kaltsas ◽  
Genovefa Papanicolaou
Keyword(s):  
Cancer Patients ◽  
Conjugate Vaccine ◽  
Indirect Effect ◽  
Pneumococcal Conjugate Vaccine ◽  
Pneumococcal Pneumonia ◽  
Hematologic Malignancies ◽  
Childhood Immunization ◽  
Radiographic Findings ◽  
Sputum Production ◽  
The Impact

Abstract Background Invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NB-PNA) are associated with substantial morbidity and mortality in cancer patients. IPD incidence among cancer patients at MSKCC sharply declined after the introduction of routine childhood immunization with the 7-valent pneumococcal conjugate vaccine (PCV7) (1). An indirect effect of PCV on pneumococcal pneumonia incidence has also been reported (2, 3). The impact of PCV on the incidence of NB-PNA in patients with cancer has not been well studied. Methods Retrospective review of patients treated at MSKCC, 1993–2012. Unique patient visits (UPV) per year were defined as ≥1 inpatient or outpatient encounter within one calendar year. NB-PNA was defined as Isolation of Streptococcus pneumoniae from sputum or bronchoalveolar lavage (BAL); with associated symptoms (cough, sputum production, and/or fever) and radiographic findings compatible with pneumonia on chest radiograph or computerized chest tomography. NB-PNA incidence was calculated as number of NB-PNA cases per 1000 UPV. Three-time periods were examined: “before PCV7” (1993–2000), “after PCV7” (2001–2010), “after PCV13” (2011–2012). Results Of 323 NB-PNA cases, S. pneumoniae was isolated from BAL in 64 (20%) and sputum in 259 (80%). 182 (56%), 121 (37%), and 20 (7%) NB-PNA cases occurred “before PCV7,” “after PCV7,” and “after PCV13,” respectively. The incidence of NB-PNA was highest in patients with hematologic malignancies and in patients ≥65 years during all three periods (Table 1). NB-PNA incidence was lower “after PCV7” compared with “before PCV7” (0.47 vs. 0.13, P < 0.001). A non-statistically significant lower incidence of NB-PNA was noted “after PCV13” vs. “after PCV7” (0.13 vs. 0.09, P = 0.19). The highest decline of NB-PNA after PCV7 introduction was observed in patients ≥65 years (0.67 vs. 0.16, P < 0.001). Conclusion (1) The incidence of NB-PNA in adult cancer patient declined after PCV7 compared with before PCV7. (2) The reduction in NB-PNA was highest in patients ≥65 years suggesting an indirect effect from PCV7 childhood immunization. (3) A trend toward decreased incidence in NB-PNA was noted after PCV13; further surveillance is required to ascertain this trend. Disclosures All authors: No reported disclosures.

Home-based management of cancer patients (CPs) experiencing toxicities while on anticancer treatment: The impact of a nurse-led telephone triage (NTT).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2002-2002
Author(s):  
Lorenzo Calvetti ◽  
Marta Tealdo ◽  
Roberta Cimenton ◽  
Angela Gentile ◽  
Rachele Pretto ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cost Savings ◽  
Successful Implementation ◽  
Chi Square ◽  
Early Management ◽  
Home Based ◽  
Anticancer Treatment ◽  
New Treatment ◽  
Grade 3 ◽  
The Impact

2002 Background: Novel organization models are needed to ensure early management of new treatment-related toxicity of anticancer treatments. Aim of this prospective observational study was to evaluate the impact of the introduction of NTT in reducing hospitalization of CPs. Methods: CPs on active medical treatment at the Department of Oncology of San Bortolo Hospital (Vicenza, Italy) were given instructions to refer to NTT in case of treatment-related adverse events (TRAEs). The service was opened Mon to Fri from 8am to 8pm. Assessment of TRAEs was performed by trained oncology nurses according to the CTCAE scale and subsequent actions were taken according to the severity of the events. The assessment was made under supervision of a medical oncologist in charge of the service while on duty. Primary endpoint of the study was to compare the rate of hospitalization of CPs on anticancer treatment after the introduction of NTT compared to 2017-2018 period. Results: From September 2018 to September 2019 1,075 patients received systemic anticancer treatment (versus 936 patients in the equivalent 2017 – 2018 period). Total consultations at NTT were 429; 581 TRAEs were reported. 117 patients reported more than one TRAE. CTCAE were graded as G1 237 (40.8%), G2 231 (39.8%) or G3-G4 113 (19.4%). The most common grade ≥ 3 TRAE was fever (38 events (33.6%) that resulted a febrile neutropenia in 7 cases) followed by cancer pain (15 (13.3%)) and fatigue (9 (8%)). In the observation period, 109 CPs on treatment were hospitalized versus 138 in the 2017-2018 period with a normalized hospitalization rate of 10.1% versus 14.7 % (p = 0.002, chi-square) with a reduction of normalized number of hospitalizations of 44 (estimated cost savings of 380.160 euros). Conclusions: Our results provided evidence of successful implementation of the NTT system in reducing rates of hospitalization through emergency room in cancer patients receiving modern medical treatments.

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 Impact of prior cancer history on the survival of patients with larynx cancer

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kaiquan Zhu ◽  
Renyu Lin ◽  
Ziheng Zhang ◽  
Huanqi Chen ◽  
Xingwang Rao
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Protective Factor ◽  
Larynx Cancer ◽  
Prior History ◽  
Second Primary ◽  
Cancer History ◽  
History Of ◽  
The Impact ◽  
History Of Cancer

Abstract Background Patients with a prior history of cancer are commonly excluded from clinical trial. Increasing number of studies implied that a prior cancer did not adversely affect the clinical outcome among various types of cancer patients. However, the impact of prior cancer on survival of larynx cancer patients remains largely unknown. The aim of this study was to evaluate the prevalence of prior cancer and assess its impact on survival of patients diagnosed with larynx cancer. Methods Patients with larynx cancer as the first or second primary malignancy diagnosed from 2004 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was conducted to balance baseline characteristics. Kaplan-Meier method, multivariate Cox proportional hazard model, and multivariate competing risk model were performed for survival analysis. Results A total of 24,812 eligible patients with larynx cancer were included in the study, wherein a total of 2436 patients (9.8%) had a prior history of cancer. Prostate (36%), lung and bronchus (10%), urinary bladder (7%), and breast (6%) were the most common types of prior cancer. A prior cancer history served as a risk factor for overall survival (AHR =1.30; 95% CI [1.21–1.41]; P < 0.001) but a protective factor for cancer-specific mortality (AHR = 0.83; 95% CI [0.72–0.94]; P = 0.004) in comparison with those without prior cancer. The subgroup analysis showed that a prior history of cancer adversely affected overall survival of patients with larynx cancer in most subgroups stratified by timing and types of prior cancer, as well as by different clinicopathologic features. Conclusion Our study indicated an adverse survival impact of a prior history of cancer on patients with larynx cancer. Except for a few particular prior cancer, clinical trials should be considered prudently for laryngeal cancer patients with prior cancers.

scholarly journals 633Poorly controlled diabetes is a predictor of colorectal cancer survival

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Ming Li ◽  
David Roder
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Cancer Survival ◽  
Epidemiological Studies ◽  
Colorectal Cancer Survival ◽  
Increased Risk ◽  
History Of ◽  
Colorectal Cancer Patients ◽  
The Impact

Abstract Background Epidemiological studies have shown diabetes associated with increased risk of colorectal cancer. This study investigates the impact of a pre-cancer diabetes-related hospitalization record on colorectal cancer survival. Methods A retrospective cohort of 13190 colorectal cancer patients recorded on the South Australian Cancer Registry in 2003-2013 were examined. Diabetes-related hospitalization histories were obtained using linked inpatient data. Colorectal cancer deaths were available for 2003-2013. The association of survival from colorectal cancer with diabetes-related hospitalization history was assessed using competing risk analysis, adjusting for sociodemographic factors and cancer stage at diagnosis. Results 2765 patients with colorectal cancer (26.5%) had a history of hospital admission for diabetic complications, the most common being multiple complications (32%), followed by kidney and eye complications. The 5- and 10-year cancer survival probabilities were 63% and 56% in those with a diabetes complication history, significantly lower than 66% and 60% for patients without these complications (adjusted sub hazard ratio 1.11, 95% CI 1.02-1.20). Risk of colorectal cancer death was lower when theses diabetes-related hospitalizations were earlier than the year of cancer diagnosis - i.e., adjusted SHR 0.80, 95% CI 0.66-0.97 for 3-5 and 0.76, 95% CI 0.59-0.98 for 6+ years before the cancer diagnosis compared with same-year hospitalizations. Conclusions Colorectal cancer patients with a history of diabetes-related hospitalization have poorer survival, particularly if these hospitalizations were in the same year as the cancer diagnosis. Key messages Poorly controlled diabetes histories predict increased risk of colorectal cancer mortality.

Sign in / Sign up

Export Citation Format

Share Document