Methods: The core members trained to conduct a PAST were an Infectious Diseases (ID) physician, ID pharmacist, PGY2 ID pharmacy resident, and five PGY1 pharmacy practice residents. Patients were identified through ID physician consult and/or antimicrobial stewardship team rounds. Patients greater than 18 years old were considered for PAST if they had a history of a type 1, or unknown, allergic reaction to penicillin that occurred greater than 5 years ago and a beta-lactam antibiotic was indicated. Patients were excluded for the following reasons: pregnancy, non-type 1 allergic reaction, and recent use of anti-histamines. The primary objective was to reduce the use of alternative antimicrobials such as carbapenems, vancomycin, and fluoroquinolones. Secondary objectives included tolerability of the PAST and beta-lactam therapy, and days of alternative antibiotics avoided.
Results: 58 PASTs were initiated from October 2015 to April 2018. Fifty-six out of 58 (97%) patients completed a PAST. Of the 56 patients that completed a PAST, the negative predictive value was 100%. The most common antibiotics prior to PAST were vancomycin, cefepime, and fluoroquinolones. The most common antibiotics after PAST were penicillin, piperacillin/tazobactam, and amoxicillin/clavulanate. Bacteremia and skin and soft tissue infection were the most common indication and Enterococcus and Streptococcus sp. were most frequently isolated. Of the 50 patients that were transitioned to a preferred beta-lactam, the number of days of alternative antibiotics avoided ranged from 2 to 180, with a mean of 22.2 days and median of 11 days.
Conclusion: Incorporating a pharmacist-managed PAST service into a community hospital’s antimicrobial stewardship program can improve the utilization of preferred antimicrobial therapy and avoid toxic, more costly antimicrobials.
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