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Published on: August 30, 2018
The incidence of antimicrobial allergies in hospitalized patients: implications regarding prescribing patterns and
C E Lee1, T R Zembower, M A Fotis
1Northwestern Memorial Hospital, Galter Carriage House, Room 701B, 215 E Chicago Ave, Chicago, IL 60611, USA. clee@nmh.org
Background:
The development of antimicrobial guidelines is one way in which institutions attempt to control emerging resistance, but the real challenge falls on promoting and ensuring adherence to these guidelines. Investigating reasons for the prescribing of alternative antimicrobial agents outside of these guidelines is crucial for modifying practices that may adversely impact institutional antimicrobial goals.
Methods:
Retrospective cross-referencing of computerized pharmacy printouts and concurrent manual medical record review.
Results:
Approximately 25% (470/1893) of the patients requiring antimicrobial therapy reported an allergy to at least 1 antimicrobial agent. The most commonly reported antimicrobial allergy was penicillin (295/1893 [15.6%]). Eighty-five patients (18.1%) reported having an allergy to 2 or more antimicrobial agents. Only 4% (27/601) of the reported antimicrobial allergies contained documentation as to the nature of the specific allergic reactions, while a manual medical record review revealed that 32% (23/73) of the antimicrobial allergies contained documentation of the specific allergic reaction. Ninety-eight (39. 7%) of 247 patients reporting an allergy only to penicillin and/or cephalosporin received vancomycin in comparison with 247 (17.4%) of 1423 patients without any antimicrobial allergies (P<.001). Similarly, 53 (21.5%) of 247 patients with reported penicillin and/or cephalosporin allergies received levofloxacin compared with 114 (8.0%) of 1423 patients without any antimicrobial allergy (P<. 001).
Conclusion:
The incidence of penicillin allergy at our institution exceeds population averages. This finding, in combination with limited documentation of drug allergies, appears to lead to the prescribing of alternative antimicrobial agents that do not fit into institutional antimicrobial guidelines and, in some instances, may put the patient at risk for infection and/or colonization with resistant organisms. Use of these alternative agents may adversely impact the ability to manage emerging antimicrobial resistance.
Insights
High rates of reported penicillin allergies and poor documentation lead to prescribing alternative antimicrobials, potentially increasing antimicrobial resistance. This practice deviates from institutional guidelines, impacting patient care and resistance management.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Antimicrobial Stewardship
Background:
- Antimicrobial guidelines aim to control resistance, but adherence is challenging.
- Understanding deviations from guidelines is key to improving antimicrobial use.
- Prescribing alternative agents outside guidelines can negatively impact institutional goals.
Purpose of the Study:
- To investigate the reasons for prescribing alternative antimicrobial agents outside institutional guidelines.
- To assess the impact of reported antimicrobial allergies on prescribing patterns.
- To evaluate the documentation quality of reported drug allergies.
Main Methods:
- Retrospective analysis of pharmacy data.
- Manual review of medical records for allergy documentation.
- Cross-referencing patient data to identify prescribing patterns.
Main Results:
- 25% of patients reported at least one antimicrobial allergy, with penicillin being most common.
- Documentation of specific allergic reactions was poor (4% in pharmacy data, 32% in medical records).
- Patients with reported penicillin/cephalosporin allergies were more likely to receive vancomycin or levofloxacin.
Conclusions:
- The high incidence of reported penicillin allergy and limited documentation contribute to the use of non-guideline antimicrobials.
- Prescribing alternative agents may increase patient risk for resistant organism infections.
- This practice can adversely affect the management of emerging antimicrobial resistance.
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