3 results
Heterogeneous OPAT regimens within and across infection diagnoses: Day-level medication use patterns among 2072 OPAT patients
- Madison Ponder, Renae Boerneke, Asher Schranz, Michael Swartwood, Claire Farel, Alan Kinlaw
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, pp. s43-s44
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Background: Patients receiving outpatient parenteral antimicrobial therapy (OPAT) are often medically complex and require carefully tailored treatments to address severe and often concomitant infections. Our objective was to illustrate the heterogeneity in antimicrobials used for patients in OPAT, within and across infection diagnosis groups. Methods: We abstracted electronic health record data regarding day-level treatment into a registry of 2,358 OPAT courses (n = 2,072 unique patients) treated in the University of North Carolina Medical Center OPAT program during 2015–2022 (total, 11,861 person weeks; average, 7 OPAT weeks per patient). We classified infection diagnoses into 10 hierarchical or mutually exclusive categories (eg, bacteremia only, diabetic foot infection (DFI) only, osteomyelitis only) (Fig., vertical axes). Accounting for 64 antimicrobial medications and 520 cocktails administered for at least 1 patient day in our OPAT registry, we also defined 18 hierarchical or mutually exclusive classifications of treatment (eg, “daptomycin alone” or “daptomycin and any other antibiotic(s)” (Fig. key). We conducted 2 stratified analyses to describe the heterogeneity across infection diagnoses with respect (1) to medications used at OPAT initiation (patient as unit of analysis) and (2) to medications used throughout OPAT (person time as unit of analysis, allowing for differential OPAT course to other treatment classifications during follow-up). We present stacked bar charts to visualize the intersection between infection diagnosis and treatment group. Results: Among patients in this OPAT registry, 34.6% had osteomyelitis and/or DFI, 4.8% had bacteremia, and 44.6% had multiple infections (Fig. 1). The most common medications in initial OPAT regimens were vancomycin (30.8% of OPAT patients), ceftriaxone (15.0%), and daptomycin (10.9%). We observed overall similarity between the distribution of treatment groups at initiation compared to cumulative person-time during the OPAT course (Figs. 1 and 2). However, we observed heterogeneity in medications by infection diagnosis (Figs. 1 and 2); for example, vancomycin was used in 39% of osteomyelitis cases but only 14% for endocarditis (Fig. 2). For several infection groups (eg, osteomyelitis, DFI, multiple infections, “other” single infections), no treatment classification exceeded 20% use (Figs. 1 and 2). Conclusions: Day-level data on medication use in this monitored registry of patients provided evidence of heterogeneity in the types of medications used throughout treatment in OPAT, which varies within and across infection diagnoses. These data highlight the need for multilayered ascertainment of medication exposure in this medically complex patient population to inform surveillance for adverse effects and guide comparative effectiveness research for postdischarge antibiotic treatment.
Disclosures: None
Evaluation of Penicillin Allergies and an Allergy Assessment Pilot in the Emergency Department
- Ashlyn Norris, Kalynn Northam, Lindsay Daniels, Mildred Kwan, Gary Burke, Nikolaos Mavrogiorgos, Renae Boerneke
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s39
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Penicillin (PCN) allergy is one of the most frequently reported medication allergies, with ~10% of the US population reporting a PCN allergy. However, studies have shown that only 1% of the US population have a true IgE-mediated reaction to PCN. Delabeling and appropriately updating patient allergy profiles could decrease the use of alternative broad-spectrum antibiotics, rates of infectious complications [C. difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE)], antibiotic resistance, and overall healthcare cost. The emergency department (ED) is an important setting in which to assess PCN allergies and to delabel patients when appropriate because there are >130 million ED visits in the United States each year. We sought to determine the percentage of PCN allergy–labeled patients who could be delabeled through a PCN allergy assessment interview in an ED. Key secondary outcomes included the percentage of interviewed patients who could not be delabeled based on history alone but would be eligible for an amoxicillin oral challenge or a PCN skin test (PST). A prospective PCN allergy assessment pilot was performed for patients aged >18 years presenting to the UNC Medical Center ED between December 1 and December 17, 2020, with a documented PCN allergy. A pharmacist conducted penicillin allergy assessments on a convenience sample of patients presenting to the ED between 8 a.m. and 3 p.m. on weekdays. Based on patients’ reported and documented histories, charts were updated with the most accurate information and allergies were delabeled if appropriate. In total, 95 patients were assessed; 62 (65.3%) were interviewed and 15 (24.2%) were delabeled. In addition, 26 patients (41.9%) were deemed eligible for an oral amoxicillin challenge, 19 (30.6%) qualified for a PST, and 2 (3.2%) patients did not qualify for further assessment due to having a an IgE-mediated reaction in the past 5 years. Of the 15 patients who were delabeled, 6 (40.0%) received antibiotics during their admission: 4 (73.3%) of those patients received a penicillin and 2 (36.7%) received a cephalosporin, all without adverse reactions. Patient assessments took ~20 minutes to complete, including chart review, patient interview, and postinterview chart updating. The results from this pilot study demonstrate the impact of performing PCN allergy assessments in ED. Interdisciplinary opportunities should be explored to develop processes that will improve the efficiency and sustainability of PCN allergy assessments within the ED to allow this important stewardship intervention to continue.
Funding: No
Disclosures: None
Evaluation of Penicillin Allergy Prevalence and Antibiotic Prescribing Patterns for Patients within the Emergency Department
- Ashlyn Norris, Lindsay Daniels, Nikolaos Mavrogiorgos, Kalynn Northam, Mildred Kwan, Gary Burke, Renae Boerneke
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s38
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As the point of entry into healthcare for many patients, the emergency department (ED) is an ideal setting in which to assess penicillin (PCN) allergies. An estimated 10% of the United States population has a reported PCN allergy; however, few studies have evaluated the prevalence and impact of PCN allergies on antibiotic selection within the ED. Patients with a documented PCN allergy are more likely to be exposed to costly alternative broad-spectrum antibiotics that have higher rates of adverse events, including C. difficile infections. We sought to determine the prevalence of PCN allergies within the UNC Medical Center ED. Key secondary outcomes included the percentage of patients with a documented PCN allergy who (1) received alternative antibiotics (carbapenems, aztreonam, fluoroquinolones, clindamycin, vancomycin), (2) received β-lactam antibiotics and experienced an allergic reaction during their ED visit, and/or (3) had received a β-lactam antibiotic during a past hospitalization or ED visit without their chart being appropriately updated. A retrospective evaluation included patients aged >18 years with a documented PCN allergy who were discharged from the ED between January 1, 2017, and December 31, 2019. Over the study period, there were 14,635 patient encounters with a documented PCN allergy that comprised 8,573 unique patients. The prevalence of PCN allergies was 14.3% for all ED encounters. PCN allergy–labeled patients received alternative antibiotics in 59.4% of ED encounters in which antibiotics were prescribed. Of the 454 β-lactam antibiotics (62 penicillins, 380 cephalosporins, 12 carbapenems) administered to PCN allergy-labeled patients within the ED, there were zero allergic reactions. Also, 18.6% of PCN allergy-labeled patients had received and tolerated a β-lactam antibiotic during prior hospitalizations or ED visits (1.7% penicillins, 14.4% cephalosporins, 2.6% carbapenems) without appropriate updated documentation to reflect β-lactam antibiotic tolerance. These findings confirm the utilization of non–β-lactam antibiotics in PCN allergy-labeled patients, highlighting the importance of accurate and updated allergy documentation in the electronic medical record. These findings also demonstrate the need for improved allergy documentation and protocols to proactively assess penicillin allergy labels while in the ED.
Funding: No
Disclosures: None