β-lactam exposure outcome among patients with a documented allergy to penicillins post-implementation of a new electronic medical record system and alerting rules
Bibliographic record
Abstract
Background: Recent studies suggest that type I hypersensitivity cross-reactivity between β-lactam antibiotics is due to side chain similarity and not the common β-lactam ring. As a result, the prescriber-alerting rules of an electronic medical record (EMR) system were adjusted to only flag prescribers when prescribing penicillins or β-lactams with similar side chains (viz, cephalexin, cefadroxil, and cefoxitin) to patients with a documented allergy to penicillins. This study was conducted to assess and confirm the safety of the adjusted alerting rules; the primary outcome was the prevalence of anaphylaxis on β-lactam re-exposure. Methods: Retrospective chart review was conducted for patients who, under the reformed alerting rules, received a β-lactam antibiotic post-documentation of an allergy to penicillins in their EMR from April 2018 to July 2019 at a 268-bed community hospital. Given the volume of eligible patients, a 25% sample was randomly selected for review from initiation of the β-lactam antibiotic up to 30 days post-exposure to determine the prevalence of anaphylaxis. Results: Of the 325 charts reviewed, 300 patients (92.3%) received a β-lactam antibiotic with a different side chain than penicillins (not alerted on prescribing). Chart review of these 300 patients confirmed no reports of anaphylaxis secondary to β-lactam exposure (0%), and two patients developed non-anaphylactic delayed reactions (rash). Conclusions: There were no reports of immediate life-threatening anaphylaxis under the reformed alerting rules, despite 25 patients (7.7%) receiving an alerted drug, such as piperacillin-tazobactam. The reformed alerting rules better reflect current literature and reduce the risk of prescriber-alerting fatigue without compromising patient safety. The occurrence of delayed reactions reinforced the need to monitor for these reactions on β-lactam antibiotic prescribing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".