Analysis of the use and influencing factors of cephalosporins after the routine skin test was cancelled in a tertiary hospital
PENG Min1, PAN Yong2, DAI Yingchun1, CHEN Li1, YAN Xiao1, LI Wei2, Deng Yinhua1
1. Hunan Provincial People's Hospital / The First Affiliated Hospital of Hunan Normal University, Changsha 410005, China; 2. Hunan Cancer Hospital, Changsha 410013, China
Abstract:Objective A questionnaire survey was used to evaluate the knowledge of medical staff in a certain hospital on cephalosporin skin test, to determine the impact of the policy of “phasing out cephalosporin skin test “ on the use of inpatient cephalosporins, and to provide reference for the sustainable advancement of this work. Methods Statistics and analysis of cephalosporin use in June-September 2020 and June-September 2021. A quesionnaire was distributed to each clinical department by the clinical pharmacy department in the hospital to investigate the attitudes of doctors, nurses and pharmacists to cancel the routine skin test of cephalosporin and the corresponding countermeasures. Results After the skin test was cancelled, the amount of cephalosporins was significantly decreased, and the proportion of total defined daily doses (DDDs) decreased (25.24%vs 24.41%). A total of 328 medical workers were surveyed, and doctors, nurses and pharmacists accounted for 26.83%, 63.72%, and 9.45%, respectively. Only 41.46% knew that the hospital implemented the policy of “phasing out cephalosporin skin test”, and 51.23% of the respondents supported “phasing out cephalosporin skin test”. The main reason for disapproval (53.96%) is that “skin test is an effective screening method to assess whether patients are allergic to cephalosporins”. The univariate chi-square test showed that there was no significant difference in each factor (including gender, age, highest education, department, and working years) for “after canceling the routine skin test, will the patient still be given a skin test?”.81.71% thought that the most common description of the history of cephalosporin allergy was a positive skin test, and 80.49% would avoid the use of cephalosporin because of a positive skin test in the past. Nurses' correct interpretation of the configuration, operation method and results of the cephalosporin skin test solution accounted for 35.58%, 3.37%, and 75.00%, respectively, and the univariate chi-square test showed that there were significant differences between departments. The main influencing factors for the correct “method of preparing cephalosporin skin test solution”. Conclusion There are still many misunderstandings about the knowledge of cephalosporin skin test among medical workers in this hospital, and after the cancellation of routine cephalosporin skin test, routine skin test is still performed or the use of cephalosporin antibiotics is reduced. Clinical pharmacists should actively respond to national policies, strengthen communication and training with clinical clinics, and eliminate the concerns of medical workers. With the assistance of clinical medical care and information systems, we will jointly promote the implementation and promotion of policies.
彭敏, 潘勇, 戴迎春, 陈丽, 颜笑, 李威, 邓银华. 某三甲医院头孢菌素取消常规皮试后的使用情况及影响因素分析[J]. 金宝搏官方188学报(医学版), 2023, 20(5): 132-138.
PENG Min, PAN Yong, DAI Yingchun, CHEN Li, YAN Xiao, LI Wei, Deng Yinhua. Analysis of the use and influencing factors of cephalosporins after the routine skin test was cancelled in a tertiary hospital. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(5): 132-138.
[1] Chaudhry S B, Veve M P, Wagner J L .Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity[J]. Pharmacy, 2019, 7(3): 103. [2] Kanny G, Guenard L, Demoly P, et al.Severe drug allergy: The first 100 cases declared to allergy vigilance network[J]. Journal of Allergy & Clinical Immunology, 2005, 115(2): S183-S183. [3] Yoon S Y, Park S Y, Kim S, et al.Validation of the cephalosporin intradermal skin test for predicting immediate hypersensitivity: a prospective study with drug challenge[J]. Allergy, 2013, 68(7): 938-944. [4] 孟娟. 其他国家及地区青霉素和头孢菌素给药前为何不进行常规皮试过敏筛查[J]. 中华临床免疫和变态反应杂志, 2021, 15(3): 355-356. [5] Infectious Diseases Society of Taiwan, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, et al. Recommendations for penicillin skin testing in Taiwan[J]. J Microbiol Immunol Infect, 2014, 47(1): 79-80. [6] 国家卫生健康委办公厅. 关于印发《β-内酰胺类抗菌药物皮肤试验指导原则 (2021 年版) 》的通知[J]. 中国实用乡村医生杂志, 2021, 28(5):1-4. [7] 桑福德. 桑福德抗微生物治疗指南[M]. 中国协和医科大学出版社, 2021. [8] Yuson C, Kumar K, Le A, et al.Immediate cephalosporin allergy[J]. Internal Medicine Journal, 2019, 49(8): 985-993. [9] Yuson C L, Katelaris C H, Smith W B .Cephalosporin allergy label is misleading[J]. Australian Prescriber, 2018, 41(2): 37-41. [10] 国家卫生计生委抗菌药物临床应用与细菌耐药评价专家委员会. 青霉素皮肤试验专家共识[J]. 中华医学杂志, 2017, 97(40): 3143-3146. [11] 禹洁, 任耘, 李蒙, 等. 天津市某三甲医院关于"取消头孢菌素皮试"的医, 护问卷调查及分析[J]. 中国医院药学杂志, 2021, 41(11): 6-7.