Evaluation of the Implementation of an Allergy Assessment Tool as an Antimicrobial Stewardship Initiative

Abstract

Background Novel antimicrobial stewardship initiatives are crucial to decrease the prevalence of multidrug-resistant pathogens and decrease morbidity and mortality at a time when the development of new antibiotic agents is slow-moving and antimicrobial resistance is increasing. The aim of this study was to compare the percentage of patients who received β-lactam therapy for the treatment of bacterial infections before and after the implementation of a formal allergy assessment protocol. This study also compared the clinical outcomes and incidence of adverse events in patients who underwent a pharmacist-driven allergy assessment to guide antibiotic therapy compared with patients who did not receive a formal allergy assessment. Methods A total of 63 adult inpatients with a β-lactam allergy reported in the electronic medical record and active orders for alternative antibiotic agents were prospectively enrolled between October 2014 and April 2015 and were compared with 63 patients at a sister hospital with similar infectious diagnoses to determine the percentage of patients transitioned to β-lactam therapy. Results The percentage of patients transitioned to β-lactam antibiotics in the intervention and control groups (63 patients each) was 36 (57%) and 14 (22%), respectively (P = 0.0019). The incidence of mortality was similar between groups at 1 (2%) of 63 patients in the intervention group and 4 (6%) of 63 patients in the control group (P = 0.168). There were no infusion-related or allergic reactions reported in the intervention group. Conclusions Standardized, pharmacist-led allergy assessments allow for easier conversion to first-line β-lactam antibiotic therapy, indicating that formal allergy assessments may serve as an important antimicrobial stewardship tool.