PAST is Present in Antimicrobial Stewardship: A Quality Initiative Targeting Inappropriate Use of Aztreonam using a Penicillin Allergy Screening Tool
Aztreonam (AZ) is a commonly prescribed second-line agent for the treatment of Gram-negative infections, particularly in patients with a self-reported β-lactam allergy (BLA). Upon review of orders at our hospital, half of AZ orders were eligible to substitute alternative β-lactam antibiotics based on BLA description. We developed an initiative comprised of a penicillin-allergy screening tool (PAST) and focused provider education to decrease inappropriate aztreonam (IA) orders.
Baseline data was collected from January to June, 2013, for patients age ≥ 18 years with a pending or verified AZ order. BLA history and prior use were assessed. Post-education data was prospectively collected from September 2013 to February 2014 using the same criteria.
From July to August 2013, pharmacists and prescribers were detailed with an educational campaign, which included the PAST, didactic lectures, and newsletters. Electronic order sets were revised to include evaluation of BLA history, with suggested first-line β -lactam alternatives in low risk histories. AZ order review with feedback occurred daily by the antimicrobial stewardship team and pharmacists.
History of tolerating cephalosporin antibiotics or absence of high risk BLA history, both determined per pharmacy administration data or patient report, defined an IA order. Outcomes included total IA Days of Therapy (DOT)/1000 patient days, IA days and doses/patient, and allergic reactions.
A total of 497 AZ orders were reviewed (304 at baseline, 193 post-education). Total IA DOT decreased from 9.6/1000 patient days to 4.3/1000 patient days between the two periods (p =0.178). IA orders were switched to β-lactam alternatives in 62/147 cases (42%) at baseline and 57/88 (65%) post-education (p =0.001). The median number of IA doses decreased from 4 doses/patient to 1 dose/patient (p < 0.001), and DOT was reduced from 2 days/patient to 1 day/patient (p < 0.001). One patient developed a rash after being switched to a β-lactam alternative post-education.
A PAST combined with provider and pharmacist education comprised a safe and effective intervention to significantly reduce inappropriate use of aztreonam at our facility by promoting safe use of first-line β-lactam alternatives.
A. Ramsey, None
A. Yamshchikov, None
M. Laguio-Vila, None