35. Broad spectrum antibiotic use in relation to β-lactam allergies
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area

Background: B-lactam antibiotics, in particular penicillins, are the most commonly reported drug allergies in the United States; however, only 10% of patients are truly allergic when tested. Patients with a B-lactam reaction documented in their electronic health record more commonly receive excessively broad-spectrum antibiotics; not only are B-lactams commonly first-line therapy for various infections, alternative therapies carry their own toxicities, costs and increased risk of antimicrobial resistance. Inaccurate B-lactam allergy documentation has been shown to adversely affect health outcomes.

Methods: A retrospective chart review of meropenem, aztreonam & linezolid use over a 6-month period was conducted at a county medical center. These antibiotics were selected as they have been previously identified as common alternative therapies for patients carrying B-lactam antibiotic reactions within the institution. Analysis included antibiotic allergy documentation, therapeutic indication, & appropriateness of therapy. B-lactams were defined as penicillins, penicillin-derivatives, or cephalosporins; carbapenems were not included in this definition for the purpose of this review.

Results: A total of 296 encounters (257 unique patients) were reviewed. The most common indication for therapy was lower respiratory infection (24%). Of patients reviewed, 35% had a documented B-lactam reaction; however, the majority of reactions were ineffectively described. The most common reaction was rash (47%), followed by type I hypersensitivity (28%), unknown (12%), and intolerance (9%). Per reviewers assessment, 83 out of 296 cases (28%) received an aforementioned antibiotic due to history of B-lactam reaction.

Conclusion: Over one-third of patients receiving broad-spectrum antibiotics had a documented B-lactam allergy, however most were ineffectively described. Improved documentation may help distinguish true allergies from intolerances and reduce broad-spectrum antibiotic use.

Rachel LaNasa, MD, Infectious Diseases, University of Minnesota, Minneapolis, MN, Muthu Narayan, DO, MPH, Infectious Diseases Department, University of Minnesota, Minneapolis, MN, Aileen Ahiskali, PharmD, Infectious Diseases, Hennepin Healthcare, Minneapolis, MN and Rebecca Zadroga, MD, Infectious Disease, Hennepin County Medical Center, Minneapolis, MN

Disclosures:

R. LaNasa, None

M. Narayan, None

A. Ahiskali, None

R. Zadroga, None

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