Adherence and outcomes of a surgical prophylaxis guideline promoting cephalosporin use among patients with penicillin allergy

Bhathal, Salfee; Joseph, Eldo; Nailor, Michael D; Goodlet, Kellie J.

doi:10.1016/j.surg.2022.01.020

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…Previous studies investigating the impact of reported penicillin allergy on hospitalization duration and treatment costs have reported conflicting results. 5 , 6 , 16 , 25 , 26 Our patient groups showed no difference in hospitalization duration and treatment costs, but this should be considered with caution as our cohort consists of patients with different surgical procedures, which in turn are associated with different hospitalization durations and costs and thus may be strong confounders for these end points.…”

Section: Discussionmentioning

confidence: 84%

Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery

Grossmann,

Kersting,

Affentranger

et al. 2023

ASHE

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Objective: Up to 10% of patients report penicillin allergy (PA), although only 1% are truly affected by Ig-E-mediated allergies. PA has been associated with worse postoperative outcomes, but studies on the impact of reported PA in cancer patients are lacking, and especially in these multimorbid patients, a non-complicated course is of utmost importance. Methods: Retrospective analysis of patients undergoing elective oncological surgery at a tertiary reference center. Data on surgical site infections (SSI), postoperative complications (measured by Clavien-Dindo classification and Comprehensive Complication Index (CCI)), hospitalization duration, and treatment costs were collected. Results: Between 09/2019 and 03/2020, 152 patients were identified. 16/152 patients (11%) reported PA, while 136/152 (89%) did not. There were no differences in age, BMI, Charlson Comorbidity Index, and smoking status between groups (p > 0.4). Perioperative beta-lactam antibiotics were used in 122 (89.7%) and 15 (93.8%) patients without and with reported PA, respectively. SSI and mean numbers of infections occurred non-significantly more often in patients with PA (p = 0.2 and p = 0.47). The median CCI was significantly higher in PA group (26 vs. 51; p = 0.035). The median hospitalization duration and treatment costs were similar between non-PA and PA groups (4 vs 3 days, p = 0.8; 16’818 vs 17’444 CHF, p = 0.4). Conclusions: In patients undergoing cancer surgery, reported PA is common. Failure to question the unproven PA may impair perioperative outcomes. For this reason, patient and provider education on which reactions constitute a true allergy would also assist in allergy de-labeling. In addition, skin testing and oral antibiotic challenges can be performed to identify the safe antibiotics and to de-label appropriate patients.

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Section: Discussionmentioning

confidence: 84%

Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery

Grossmann,

Kersting,

Affentranger

et al. 2023

ASHE

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“…15 There is emerging evidence that suggests that even patients with IgE-mediated allergic reactions can safely be given cephalosporins. 15 Further research is needed on promoting cephalosporin use in surgical patients without formal penicillin allergy testing, including in patients with true penicillin allergy. Antimicrobial stewardship requires multidisciplinary collaboration.…”

Section: Discussionmentioning

confidence: 99%

“…7 Therefore, cefazolin can be administered safely even in patients with known penicillin allergy. 15…”

Section: Discussionmentioning

confidence: 99%

“…7 Therefore, cefazolin can be administered safely even in patients with known penicillin allergy. 15 There is emerging evidence that suggests that even patients with IgE-mediated allergic reactions can safely be given cephalosporins. 15 Further research is needed on promoting cephalosporin use in surgical patients without formal penicillin allergy testing, including in patients with true penicillin allergy.…”

Section: Discussionmentioning

confidence: 99%

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Implementing Preoperative Penicillin Allergy Testing in Surgical Patients

2023

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Penicillin allergy is the most reported immunoglobulin E (IgE)-mediated reaction. About 10% of the general population and 20% of hospitalized patients have a history of penicillin allergy. Unconfirmed penicillin allergy with subsequent administration of second-line antibiotics has been associated with increased morbidity. However, when penicillin allergy testing is performed, the incidence of IgE-mediated reactions is extremely low; in fact, the negative predictive value of penicillin allergy testing exceeds 99%. This article aims to briefly describe implementing safe penicillin allergy testing as a routine test during the preoperative evaluation of surgical patients.

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“…However, if a patient has a penicillin or beta-lactam allergy, cefazolin is frequently substituted with a non-beta-lactam antibiotic to avoid the theoretical risk of cross-reaction. However, this risk is extremely low (generally quoted around 1 % or less ( Campagna et al, 2012 )and must be balanced against the disadvantages of using a non-beta-lactam antibiotic, including increased infection rates, acute kidney injury (AKI), antibiotic resistance, and costs ( Blumenthal et al, 2018 , Ahmed et al, 2022 , Bhathal et al, 2022 ). In addition, vancomycin is regularly substituted for cefazolin in penicillin allergic patients, which can result in operating delays due to the need for prolonged infusion and side effects such as AKI or vancomycin infusion reactions.…”

mentioning

confidence: 99%

Quality corner: Safely using cephalosporins in almost all patients with penicillin allergies: Mini-review and suggested protocol to improve efficacy and surgical outcomes

Boitano,

Virk,

Michael Straughn Jr

et al. 2024

Gynecologic Oncology Reports

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Adherence and outcomes of a surgical prophylaxis guideline promoting cephalosporin use among patients with penicillin allergy

Cited by 9 publications

References 28 publications

Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery

Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery

Implementing Preoperative Penicillin Allergy Testing in Surgical Patients

Quality corner: Safely using cephalosporins in almost all patients with penicillin allergies: Mini-review and suggested protocol to improve efficacy and surgical outcomes

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