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Antibiotics 2016, 5(1), 7; doi:10.3390/antibiotics5010007

Evaluation of a Computerized Decision Support Intervention to Decrease Use of Anti-Pseudomonal Carbapenems in Penicillin Allergic Patients

1
Infectious Diseases Research Fellow, Pharmacy Service, Boise Veterans Affairs Medical Center, Bldg T111, 500 W Fort St. Boise, ID 83702, USA
2
Pharmacy Informatics Program Manager, Pharmacy Service, Boise Veterans Affairs Medical Center, 500 W Fort St. Boise, ID 83702, USA
3
Biostatistician, Research Service, Boise Veterans Affairs Medical Center and Quantified Inc. T111, 500 W Fort St. Boise, ID 83702, USA
4
Clinical Pharmacist, Pharmacy Service, Boise Veterans Affairs Medical Center, and Professor of Pharmacy, College of Pharmacy, Idaho State University, Bldg T111, 500 W Fort St. Boise, ID 83702, USA
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Academic Editors: Jerod Nagel and Christopher C. Butler
Received: 29 September 2015 / Revised: 31 December 2015 / Accepted: 8 January 2016 / Published: 15 January 2016
(This article belongs to the Special Issue Antimicrobial Stewardship)
View Full-Text   |   Download PDF [783 KB, uploaded 15 January 2016]   |  

Abstract

Allergies to β-lactam antibiotics are commonly documented in hospitalized patients; however, true allergy is uncommon. Cross-reactivity rates for advanced generation cephalosporins and carbapenems are low; particularly for patients without a history of symptoms consistent with type 1 hypersensitivity. We observed that providers preferentially prescribed antipseudomonal carbapenems (APC) over advanced generation cephalosporins for patients with β-lactam allergy history, including those with low risk for antimicrobial-resistant infections. Information was inserted into the computerized decision support system (CDSS) to aid clinicians in assessing β-lactam cross-reactivity risk and selecting appropriate therapy. A retrospective evaluation was conducted in a small hospital to assess the impact of the CDSS changes in APC prescribing. Inpatients (n = 68) who received at least one APC dose during hospitalization over a 13 month pre-intervention period were compared to inpatients who received an APC during the 15 month post-intervention period (n = 59) for documented APC indications and β-lactam allergy history. APC initiations were measured and corrected per 1000 patient-days; interrupted time-series analysis was performed to assess changes in use before and after implementation. Aggregate monthly APC initiations decreased from 7.01 to 6.14 per 1000 patient-days after the implementation (p = 0.03). Post-intervention APC initiations for patients with low-risk β-lactam histories decreased from 92% to 83% (p = 0.17). No adverse events were observed in patients with low-risk β-lactam histories. The intervention was associated with a reduction in APC initiations. View Full-Text
Keywords: antimicrobial stewardship; computerized decision support system; antipseudomonal; carbapenem; β-lactam allergy; β-lactam cross-reactivity antimicrobial stewardship; computerized decision support system; antipseudomonal; carbapenem; β-lactam allergy; β-lactam cross-reactivity
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Caplinger, C.; Smith, G.; Remington, R.; Madaras-Kelly, K. Evaluation of a Computerized Decision Support Intervention to Decrease Use of Anti-Pseudomonal Carbapenems in Penicillin Allergic Patients. Antibiotics 2016, 5, 7.

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