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Leis JA, Palmay L, Ho G, Raybardhan S, Gill S, Kan T, Campbell J, Kiss A, McCready JB, Das P, Minnema B, Powis JE, Walker SAN, Ferguson H, Wong B, Weber E. Point-of-Care β-Lactam Allergy Skin Testing by Antimicrobial Stewardship Programs: A Pragmatic Multicenter Prospective Evaluation. Clin Infect Dis 2019; 65:1059-1065. [PMID: 28575226 DOI: 10.1093/cid/cix512] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/26/2017] [Indexed: 02/06/2023] Open
Abstract
Background β-lactam allergy skin testing (BLAST) is recommended by antimicrobial stewardship program (ASP) guidelines, yet few studies have systematically evaluated its impact when delivered at point of care. Methods We conducted a pragmatic multicenter prospective evaluation of the use of point-of-care BLAST by ASPs. In staggered 3-month intervals, ASP teams at 3 hospitals received training by allergists to offer BLAST for eligible patients with infectious diseases receiving nonpreferred therapy due to severity of their reported allergy. The primary outcome was the proportion of patients receiving the preferred β-lactam therapy. Results Of 827 patients with reported β-lactam allergy over 15 months, β-lactam therapy was preferred among 632 (76%). During baseline periods, 50% (124/246) received preferred β-lactam therapy based on history, compared with 60% (232/386) during the intervention periods (P = .02), which improved further to 81% (313/386) upon provision of BLAST (P < .001) without any increase in incidence of adverse drug reactions (4% vs 3%; P = .4). After adjusting for patient variables and the correlation between hospitals, the intervention period was associated with a 4.5-fold greater odds of receiving preferred β-lactam therapy (95% confidence interval, 2.4-8.2; P < .0001). Conclusions The use of BLAST at the point of care across 3 hospital ASPs resulted in greater use of preferred β-lactam therapy without increasing the risk of adverse drug reactions. Longer-term studies are needed to better assess the safety and clinical impact of this ASP intervention.
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Affiliation(s)
- Jerome A Leis
- Division of Infectious Diseases, Department of Medicine.,Sunnybrook Research Institute and Institute of Health Policy, Management and Evaluation.,Centre for Quality Improvement and Patient Safety, and
| | - Lesley Palmay
- Department of Pharmacy, Sunnybrook Health Sciences Centre, and Lesley Dan Faculty of Pharmacy, University of Toronto
| | | | | | | | | | - Jackie Campbell
- Department of Pharmacy, Sunnybrook Health Sciences Centre, and Lesley Dan Faculty of Pharmacy, University of Toronto.,Drug Safety Clinic, Sunnybrook Health Sciences Centre ; and
| | - Alex Kiss
- Sunnybrook Research Institute and Institute of Health Policy, Management and Evaluation
| | - Janine B McCready
- Division of Infectious Diseases, Department of Medicine.,Michael Garron Hospital
| | - Pavani Das
- Division of Infectious Diseases, Department of Medicine.,North York General Hospital
| | - Brian Minnema
- Division of Infectious Diseases, Department of Medicine.,North York General Hospital
| | - Jeff E Powis
- Division of Infectious Diseases, Department of Medicine.,Centre for Quality Improvement and Patient Safety, and.,Michael Garron Hospital
| | - Sandra A N Walker
- Department of Pharmacy, Sunnybrook Health Sciences Centre, and Lesley Dan Faculty of Pharmacy, University of Toronto
| | | | - Benny Wong
- North York General Hospital.,Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Ontario, Canada
| | - Elizabeth Weber
- Drug Safety Clinic, Sunnybrook Health Sciences Centre ; and.,Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Ontario, Canada
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Affiliation(s)
- Janine B McCready
- Department of Medicine, University of Toronto, Toronto East General Hospital, Ont., Canada.
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