Oct 29, 2016 - and Outcomes Sciences, South Carolina College of Pharmacy, University ... Carolina, Columbia, SC; 4Palmetto Health Baptist, Columbia, SC.
1855. Impact of Penicillin Allergy on Empiric Carbapenem Use in Patients with Community-Onset Gram-Negative Bloodstream Infections Emily Acker, PharmD1; Majdi Al-Hasan, MBBS2; Joseph Kohn, PharmD, BCPS1; P. Brandon Bookstaver, PharmD, FCCP, BCPS, AAHIVP3; Casey Troficanto, PharmD, BCPS4; Julie Ann Justo, PharmD, MS, BCPS-AQ ID3; 1Palmetto Health Richland, Columbia, SC; 2Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC; 3Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC; 4Palmetto Health Baptist, Columbia, SC Session: 221. Antibiotic Stewardship: Beta Lactam Allergy Saturday, October 29, 2016: 12:30 PM Background. Penicillin is the most commonly reported medication allergy. It often results in broader empiric antibiotic selection. The primary objective of this study is to evaluate carbapenem use as empiric therapy for community-onset gramnegative (GN) bloodstream infections (BSI) in patients with penicillin allergy (PA) versus no penicillin allergy (NPA). Secondary endpoints included impact of antimicrobial
stewardship and support team (ASST) interventions on carbapenem use and on time to carbapenem de-escalation in the PA group. Methods. This single healthcare system, retrospective, observational, matched cohort study evaluated adults hospitalized with GN BSI from 1 January 2010 to 30 June 2015. All patients with PA were enrolled and matched with control patients with NPA in a 1:1 fashion based on: age ±10 years, sex, site of acquisition (community-acquired [CA], versus healthcare-associated), and pre- versus post-ASST interventions (beginning 1 January 2014). Multivariable logistic regression was used to evaluate the impact of PA and ASST interventions on empiric carbapenem use. Results. A total of 280 patients were enrolled. Overall, the mean age was 71 years, 208 (74%) were women, 142 (51%) had CA BSI, and 64 (23%) were in the post-ASST intervention period. Empiric carbapenem use was greater in the PA versus NPA groups (27% versus 12%). After adjustment for covariates, including baseline differences in race and indwelling urinary catheters, PA remained independently associated with empiric carbapenem use (aOR 3.98, 95% CI 1.98–8.45, p < 0.001). Other predictors of empiric carbapenems included male sex (aOR 2.18, 95% CI 1.08–4.36), Bloodstream Infection Mortality Risk Score (aOR 1.19 per point, 95% CI 1.08–1.32), and prior beta-lactam use within 90 days (aOR 2.72, 95% CI 1.07–6.64). ASST interventions were associated with reduction in empiric carbapenem use (aOR 0.41, 95% CI 0.16– 0.40). Time to carbapenem de-escalation in the PA group was also significantly shorter in the post- versus pre-ASST intervention period (2.0 versus 4.2 days, p < 0.001). Conclusion. Penicillin allergy is an independent risk factor for empiric carbapenem use for community-onset GN BSI. ASST interventions successfully reduced carbapenem utilization. Disclosures. P. B. Bookstaver, Allergan Pharmaceuticals: Scientific Advisor, Research grant
Poster Abstracts
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OFID 2016:3 (Suppl 1)
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S515
