PMID- 31660339
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220411
IS  - 2328-8957 (Print)
IS  - 2328-8957 (Electronic)
IS  - 2328-8957 (Linking)
VI  - 6
IP  - 10
DP  - 2019 Oct
TI  - The Impact of Penicillin Skin Testing on Aztreonam Stewardship and Cost Savings 
      in Immunocompromised Cancer Patients.
PG  - ofz371
LID - 10.1093/ofid/ofz371 [doi]
LID - ofz371
AB  - OBJECTIVE: Reported penicillin allergies result in alternative antimicrobial use 
      and are associated with worse outcomes and increased costs. Penicillin skin 
      testing (PST) has recently been shown to be safe and effective in 
      immunocompromised cancer patients, yet its impact on antimicrobial costs and 
      aztreonam utilization has not been evaluated in this population. METHOD: From 
      September 2017 to January 2018, we screened all admitted patients receiving 
      aztreonam. Those with a self-reported history of possible immunoglobulin E 
      (IgE)-mediated reaction to penicillin were eligible for PST with oral challenge. 
      RESULTS: A total of 129 patients were screened, and 49 patients were included and 
      underwent testing. Sixteen patients (33%) had hematologic malignancies and 33 
      patients (67%) had solid tumors. After PST with oral challenge, 46 patients (94%) 
      tested negative, 1 patient tested positive on oral challenge, and 2 patients had 
      indeterminate results. The median time from admission to testing was 2 days 
      (interquartile range, 1-4). After testing negative, 33 patients (72%) were 
      switched to beta-lactam therapy, which resulted in a total of 390 days of 
      beta-lactam therapy. For identical therapy durations, the direct total antibiotic 
      cost was $15 138.89 for beta-lactams versus $78 331.50 for aztreonam, resulting 
      in $63 192.61 in projected savings. A significant reduction in median days of 
      aztreonam therapy per 1000 patient days (10.0 vs 8.0; P = .005) was found during 
      the intervention period. CONCLUSIONS: Use of PST in immunocompromised cancer 
      patients receiving aztreonam resulted in improved aztreonam stewardship and 
      significant cost savings. Our study demonstrates that PST with oral challenge 
      should be considered in all cancer patients with reported penicillin allergies.
CI  - (c) The Author(s) 2019. Published by Oxford University Press on behalf of 
      Infectious Diseases Society of America.
FAU - Foolad, Farnaz
AU  - Foolad F
AD  - Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston.
FAU - Berlin, Sheila
AU  - Berlin S
AD  - Department of Infectious Diseases, Infection Control, and Employee Health, The 
      University of Texas MD Anderson Cancer Center, Houston.
FAU - White, Candice
AU  - White C
AD  - Department of Infectious Diseases, Infection Control, and Employee Health, The 
      University of Texas MD Anderson Cancer Center, Houston.
FAU - Dishner, Emma
AU  - Dishner E
AD  - Department of Infectious Diseases, Infection Control, and Employee Health, The 
      University of Texas MD Anderson Cancer Center, Houston.
FAU - Jiang, Ying
AU  - Jiang Y
AD  - Department of Infectious Diseases, Infection Control, and Employee Health, The 
      University of Texas MD Anderson Cancer Center, Houston.
FAU - Taremi, Mahnaz
AU  - Taremi M
AD  - Department of Infectious Diseases, Infection Control, and Employee Health, The 
      University of Texas MD Anderson Cancer Center, Houston.
LA  - eng
PT  - Journal Article
DEP - 20190823
PL  - United States
TA  - Open Forum Infect Dis
JT  - Open forum infectious diseases
JID - 101637045
PMC - PMC6767966
OTO - NOTNLM
OT  - allergy testing
OT  - antimicrobial stewardship
OT  - aztreonam
OT  - cost savings
OT  - penicillin allergy
EDAT- 2019/10/30 06:00
MHDA- 2019/10/30 06:01
PMCR- 2019/08/23
CRDT- 2019/10/30 06:00
PHST- 2019/06/19 00:00 [received]
PHST- 2019/08/20 00:00 [accepted]
PHST- 2019/10/30 06:00 [entrez]
PHST- 2019/10/30 06:00 [pubmed]
PHST- 2019/10/30 06:01 [medline]
PHST- 2019/08/23 00:00 [pmc-release]
AID - ofz371 [pii]
AID - 10.1093/ofid/ofz371 [doi]
PST - epublish
SO  - Open Forum Infect Dis. 2019 Aug 23;6(10):ofz371. doi: 10.1093/ofid/ofz371. 
      eCollection 2019 Oct.