1002. Utilization of Alternative Β-lactams in Patients with Penicillin Hypersensitivity

Abstract

BackgroundThe increased utilization of alternative agents due to recorded β-lactam allergies, such as aztreonam, fluoroquinolones, and vancomycin is leading to potentially worse clinical outcomes as well as an increase in multi-drug-resistant-organisms. We aim to determine whether β-lactam allergy evaluation conducted by a pharmacist reduces the utilization of aztreonam in patients reporting a penicillin allergy.MethodsThis single-center, retrospective study was conducted at Advocate Christ Medical Center in patients ≥18 years of age with a documented penicillin allergy initiated on aztreonam upon admission from September 1, 2017 to August 31, 2018. A pharmacist driven β-lactam allergy history evaluation protocol was initiated on March 1, 2018 to identify patients who qualified for an alternative β-lactam, rather than aztreonam. Once identified, recommendations regarding these patients was discussed with the physician. The pre-intervention group was compared with patients initiated on aztreonam post-implementation of the pharmacist driven intervention.ResultsA total of 121 patients were included; 70 in the pre-intervention group, 51 in the post-intervention group. Post-intervention, significantly more patients had appropriate β-lactam allergy history documentation in the electronic medical record (38.6% vs. 60.8%; P = 0.02). After implementation of the pharmacist driven protocol, days on aztreonam per 1000 patient-days was significantly lower in the post-intervention group (4 [3–6] vs. 3 [2–6] P = 0.04). Within the post-intervention group, 34 pharmacist interventions were attempted, with 83% of those interventions being accepted. Of these patients, 50% had antibiotics discontinued, 43% were switched to a third or fourth-generation cephalosporin, and 7% were switched to a carbapenem. None of these patients experienced hypersensitivity when challenged with an alternative β-lactam.ConclusionImplementation of a pharmacist-driven β-lactam allergy evaluation increased the appropriate use of β-lactams. Of the patients given an alternative β-lactam during their admission, none experienced a hypersensitivity reaction, which suggests their safe utilization in patients with reported penicillin hypersensitivity.Disclosures All authors: No reported disclosures.