1793. Description of a Pharmacist-Managed Penicillin Allergy Skin Testing (PAST) Service at a Community Teaching Hospital
Session: Poster Abstract Session: Antimicrobial Stewardship: Impact of Allergy
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • ID week Poster 2018_MMC PAST, NPT.pdf (801.3 kB)
  • Background: Penicillin allergies routinely result in the use of alternative antibiotics, which has shown to increase healthcare cost, length of stay, and the incidence of multi-drug resistant organisms. The goal of this study was to describe how a pharmacist-managed PAST service could be incorporated into an antimicrobial stewardship program to optimize antimicrobial therapy in patients who report a penicillin allergy and require a penicillin antibiotic.

    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.

    Nicholas Torney, Pharm.D., Pharmacy, Munson Medical Center, Traverse City, MI and Michael Tiberg, Pharm.D., Munson Medical Center, Traverse City, MI

    Disclosures:

    N. Torney, ALK Abello, Inc.: Speaker's Bureau , Speaker honorarium .

    M. Tiberg, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.