A guideline identifying when inpatients with penicillin or cephalosporin antibiotic allergy labels (PCAAL) can receive β-lactam antibiotics increased β-lactam receipt at a large northeastern United States healthcare system. OBJECTIVE: To report outcomes of implementing a similar guideline and electronic order set (OS) at an independent academic healthcare system.
Penicillin/Cephalosporin receipt (percentage of inpatients receiving full doses) and alternative antibiotic use (days-of-therapy per 1000 patient-days, DOT/1000PD) were compared over three periods before (2/1/2017-1/31/2018), after guideline implementation (2/1/3018-1/31/2019), and after OS implementation (2/1/2019-1/31/2020) among inpatients with PCAAL admitted on medical services with access to guideline/OS and education (Medical-PCAAL, n=8721), surgical services with access to guideline/OS without education (Surgical-PCAAL, n=5069), and obstetrics/gynecology services without interventions (Ob/Gyn-PCAAL, n=798) and inpatients without PCAAL admitted on the same services (Medical-No-PCAAL, n=50840; Surgical-No-PCAAL, n=29845; Ob/Gyn-No-PCAAL, n=6109). Chi-square tests were used to compare categorical variables, ANOVA to compare continuous, and interrupted time series analyses (ITSA) to investigate guideline/OS implementation effect on penicillin/cephalosporin receipt.
In the Medical-PCAAL group, penicillin/cephalosporin receipt increased (58% to 68%, p<0.001), specifically for cefazolin (8% to 11%, p=0.02) and 3rd-5th-generation cephalosporins (43% to 48%, p=0.04), and aztreonam use decreased (12 DOT/1000PD, p=0.03). In the Medical-No-PCAAL group, penicillin/cephalosporin receipt increased (88% to 90%, p=0.004), specifically for penicillin (40% to 44%, p<0.001), without changes in aztreonam use. Significant changes were not observed in these outcomes on surgical or obstetrics/gynecology services. Per ITSA, guideline/OS implementation was associated with increased penicillin/cephalosporin receipt in the Medical-PCAAL group only.
Guideline and OS implementation was associated with improved antibiotic stewardship on inpatient services that also received allergy education.

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