Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2017/06/stewardship-resistance-scan-jun-13-2017
Stewardship / Resistance Scan for Jun 13, 2017
Antibiotic side effects; Allergy history and pre-op stewardship
Filed Under:
Antimicrobial Stewardship; Clostridium difficile
[h=3]Study: Antibiotic treatment poses 20% risk of adverse events in inpatients[/h] Hospital patients who receive antibiotic treatment may face about a 20% risk of a related adverse event, if the results of a new study from Johns Hopkins University researchers can be generalized.
The authors checked the medical records of 1,488 Johns Hopkins Hospital patients for information about adverse drug events (ADEs) after they received at least 24 hours of parenteral or oral antibiotic treatment, according to their report yesterday in JAMA Internal Medicine.
The investigators looked for gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic ADEs recorded within 30 days after treatment, and for Clostridium difficile or multidrug-resistant infections that occurred within 90 days. The patients had a median age of 59 years, and 51% of them were women.
The team determined that 298 (20%) of the patients had at least one ADE. Fifty-six ADEs, including 7 C difficile infections, were in patients who had received antibiotic treatment that was considered not clinically indicated. The researchers also concluded that every additional 10 days of antibiotic treatment conferred a 3% increase in risk of an ADE.
"The most common ADEs were gastrointestinal, renal, and hematologic abnormalities, accounting for 78 (42%), 45 (24%), and 28 (15%) 30-day ADEs, respectively. Notable differences were identified between the incidence of ADEs associated with specific antibiotics," the report states.
The authors concluded that their findings "underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs."
Jun 12 JAMA Intern Med abstract
[h=3]Structured allergy history tied to better preoperative antibiotics[/h] A stewardship program that involved a structured allergy history performed by a pharmacist was associated with good results in patients who had beta-lactam allergies and underwent elective surgery at a Toronto hospital, according to a study in the Journal of Antimicrobial Chemotherapy.
The use of alternative second-line antibiotics has been associated with adverse events in patients reporting beta-lactam allergies. The study authors hypothesized that structured allergy histories, without the use of skin testing, could reduce the use of alternative prophylactic antibiotics.
They analyzed data on 485 patients whose allergy histories were detailed by a pharmacist and reviewed by an infectious disease physician. Patients were prescribed cefazolin prophylaxis if they did not describe a history of a type 1?mediated (severe) reaction. Among the total, 117 (24.1%) reported a type 1?mediated allergy history.
Of the 485 patients, 267 (55.1%) were chosen to receive cefazolin before surgery. The researchers reported no increase in serious complications. After the program was implemented, the overall rate of prophylaxis with alternative antibiotics fell from 81.9% to 55.9%.
Jun 10 J Antimicrob Chemother study
Stewardship / Resistance Scan for Jun 13, 2017
Antibiotic side effects; Allergy history and pre-op stewardship
Filed Under:
Antimicrobial Stewardship; Clostridium difficile
[h=3]Study: Antibiotic treatment poses 20% risk of adverse events in inpatients[/h] Hospital patients who receive antibiotic treatment may face about a 20% risk of a related adverse event, if the results of a new study from Johns Hopkins University researchers can be generalized.
The authors checked the medical records of 1,488 Johns Hopkins Hospital patients for information about adverse drug events (ADEs) after they received at least 24 hours of parenteral or oral antibiotic treatment, according to their report yesterday in JAMA Internal Medicine.
The investigators looked for gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic ADEs recorded within 30 days after treatment, and for Clostridium difficile or multidrug-resistant infections that occurred within 90 days. The patients had a median age of 59 years, and 51% of them were women.
The team determined that 298 (20%) of the patients had at least one ADE. Fifty-six ADEs, including 7 C difficile infections, were in patients who had received antibiotic treatment that was considered not clinically indicated. The researchers also concluded that every additional 10 days of antibiotic treatment conferred a 3% increase in risk of an ADE.
"The most common ADEs were gastrointestinal, renal, and hematologic abnormalities, accounting for 78 (42%), 45 (24%), and 28 (15%) 30-day ADEs, respectively. Notable differences were identified between the incidence of ADEs associated with specific antibiotics," the report states.
The authors concluded that their findings "underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs."
Jun 12 JAMA Intern Med abstract
[h=3]Structured allergy history tied to better preoperative antibiotics[/h] A stewardship program that involved a structured allergy history performed by a pharmacist was associated with good results in patients who had beta-lactam allergies and underwent elective surgery at a Toronto hospital, according to a study in the Journal of Antimicrobial Chemotherapy.
The use of alternative second-line antibiotics has been associated with adverse events in patients reporting beta-lactam allergies. The study authors hypothesized that structured allergy histories, without the use of skin testing, could reduce the use of alternative prophylactic antibiotics.
They analyzed data on 485 patients whose allergy histories were detailed by a pharmacist and reviewed by an infectious disease physician. Patients were prescribed cefazolin prophylaxis if they did not describe a history of a type 1?mediated (severe) reaction. Among the total, 117 (24.1%) reported a type 1?mediated allergy history.
Of the 485 patients, 267 (55.1%) were chosen to receive cefazolin before surgery. The researchers reported no increase in serious complications. After the program was implemented, the overall rate of prophylaxis with alternative antibiotics fell from 81.9% to 55.9%.
Jun 10 J Antimicrob Chemother study