Outcomes from an inpatient beta-lactam allergy guideline across a large US health system.

Objective: To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported β-lactam allergies.

Design: Retrospective cohort study.

Setting: Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.

Leveraging Quality Improvement Science to Reduce C. difficile Infections in a Community Hospital.

Background: The most common infection acquired in US hospitals is Clostridium difficile, which can lead to protracted diarrhea, severe abdominal cramping, and infectious colitis and an attributable mortality of 6.5%. The mortality associated with C.

Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation.

Addressing inaccurate penicillin allergies is encouraged as part of antibiotic stewardship in the inpatient setting. However, implementing interventions targeted at the 10% to 15% of inpatients reporting a previous penicillin allergy can pose substantial logistic challenges. We implemented a computerized guideline for patients with reported beta-lactam allergy at 5 hospitals within a single health care system in the Boston area.

Does electronic stewardship work?

Faced with national requirements to promote antimicrobial stewardship and reduce drug-resistant infections, community hospitals are challenged to make the best use of existing resources. Eighteen months after building antibiotic decision support into our electronic order platform, high-risk antibiotic use decreased by 83% (P < .001) at our community hospital.

Altered mental status and fever.

West Nile virus (WNV) is still the most common cause of neuroinvasive arboviral disease in the USA with a case death of 10-30%. We are reporting a case of a 61-year-old woman with a history of Crohn's disease, fibromyalgia treated with chronic steroid therapy that presented with a day history of fever, confusion and lethargy. She had a lumbar puncture which was notable for lymphocytosis and was positive for WNV.