Does Cephalosporin Skin Test Predict Immediate Hypersensitivity to Cephalosporin?

Choi, Jeong Hee

doi:10.3346/jkms.2019.34.e328

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…Therefore, in most hospitals in China, especially primary hospitals where medical and pharmaceutical professional skill level are relatively low and training is relatively less, a routine skin test would be carried out before cephalosporin is administered, but whether the routine skin test is required before the use of cephalosporin is controversial. 9,10 Because the metabolites of cephalosporins still cannot be identified clearly and no special-purpose reagents for the skin test are currently available, the sensitivity, specificity, and positive predictive value of the cephalosporin skin test are uncertain. 9,10 In addition, the predictive value of the routine skin test for cephalosporin (RSTC) for immediate allergic reactions is not available.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Because the metabolites of cephalosporins still cannot be identified clearly and no special-purpose reagents for the skin test are currently available, the sensitivity, specificity, and positive predictive value of the cephalosporin skin test are uncertain. 9,10 In addition, the predictive value of the routine skin test for cephalosporin (RSTC) for immediate allergic reactions is not available. 11 Furthermore, the RSTC can evoke an allergic reaction.…”

Section: Introductionmentioning

confidence: 99%

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Potential Factors of Primary Hospital Healthcare Professionals in Hindering the Abolition of Routine Skin Test for Cephalosporin: A Cross-Sectional Study

Li¹,

Li²,

Ni³

et al. 2023

RMHP

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In 2021, National Health Commission of the People's Republic of Chinese issued a document that no longer recommended the routine skin test for cephalosporin (RSTC). However, there is still resistance to the cancellation of RSTC in a primary hospital. The study aimed to explore the potential factors for hindering the abolition of the RSTC in a county-level hospital based on the PRECEDE model. Methods: The cross-sectional study was conducted on healthcare workers in the Pidu District People's Hospital, Chengdu, by online questionnaire from September 10 to September 25 in the 2021.The PRECEDE model was used to divide the potential factors of healthcare professionals in hindering the abolition of the RSTC into predisposing factors, enabling factors and reinforcing factors. Data were analyzed by ANOVA, Chi-square test, multiple linear and multiple logistic regression analysis. Results: We collected 605 respondents' valid questionnaires. 254 healthcare professionals were against cancellation of the RSTC, accounting for 41.98%. Multiple linear regression analysis showed that working for 6~10 years (β = 1.953, P = 0.024), medium (β = 1.995, P = 0.030) or senior (β = 4.003, P = 0.007) professional qualification, pharmacists (β = 3.830, P = 0.013) and working in surgical department (β= 4.462, P < 0.001) were significantly associated with higher score of predisposing factors, enabling factors, and reinforcing factors on abolition of RSTC. Furthermore, multiple logistic regression analysis showed that pharmacists (OR=3.113, 95% CI: 1.341-7.223, P=0.030), medium professional qualification (OR=1.272, 95% CI: 0.702-2.302, P=0.008), scores of predisposing factors (OR=1.335, 95% CI: 1.033-1.726, P=0.009), and scores of enabling factors (OR=1.208, 95% CI: 1.109-1.315, P<0.001) were independently associated with the positive anticipated behavior on the abolition of RSTC. While nurses (OR=0.516, 95% CI: 0.284-0.938, P<0.001) were independently associated with anticipated negative behavior. Conclusion: Pharmacists, medium professional qualification, and healthcare professionals with higher scores of predisposing and enabling factors were more likely to have a positive anticipated behavior on the abolition of RSTC, while nurses did not.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Potential Factors of Primary Hospital Healthcare Professionals in Hindering the Abolition of Routine Skin Test for Cephalosporin: A Cross-Sectional Study

Li¹,

Li²,

Ni³

et al. 2023

RMHP

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“…19 Furthermore, although patients could have a cephalosporin allergy in the absence of a penicillin allergy, penicillin allergy testing is still commonly utilized in the evaluation of a cephalosporin allergy because cephalosporin testing has neither been well validated nor standardized. 20,21 Thus, penicillin allergy testing remains the recommended intervention 22 in identifying those who could most appropriately benefit from the use of clindamycin for prophylaxis in otolaryngologic surgery. Although previous studies have shown that penicillin allergy testing is cost-saving across various scenarios, 23,24 none have evaluated its economic viability in the specific situation outlined above that is commonly encountered by otolaryngologists in the perioperative period.…”

Section: Introductionmentioning

confidence: 99%

“…Penicillin allergy testing is a reliable and validated diagnostic intervention to identify patients who truly have an IgE‐mediated hypersensitivity reaction to penicillin 19 . Furthermore, although patients could have a cephalosporin allergy in the absence of a penicillin allergy, penicillin allergy testing is still commonly utilized in the evaluation of a cephalosporin allergy because cephalosporin testing has neither been well validated nor standardized 20,21 . Thus, penicillin allergy testing remains the recommended intervention 22 in identifying those who could most appropriately benefit from the use of clindamycin for prophylaxis in otolaryngologic surgery.…”

Section: Introductionmentioning

confidence: 99%

Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis

et al. 2022

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Objective Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery. Methods A break‐even analysis was performed using the average cost of penicillin allergy testing and a CDI/SSI to calculate the absolute risk reduction (ARR) in baseline CDI/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR. Results Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability. Conclusion In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery. Level of Evidence NA Laryngoscope, 133:1086–1091, 2023

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Estudo da enzima beta-lactamase e sua relação com a resistência aos antibióticos

Araújo

Azevedo

2020

RSD

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Beta-lactam antibiotics have the same mechanism of action, the inhibition of bacterial cell wall synthesis, mainly affecting peptidoglycan. They are considered safety antibiotics, since, when they directly reach the cell wall, they cause bacterial autolysis. The objective of this research is to evaluate the affinity between the beta-lactamase enzyme and several classes of beta-lactam antibiotics. This study is a research of exploratory type methodology, of quantitative nature with application of computer simulation with application of methods with computer simulation with the evaluation of the connection scores by traditional molecular anchoring using the AutoDock 4.2 program. We identified that, in the results of molecular docking simulations, penicillin and cephalosporin showed greater affinity at the catalytic site, due to a lower Gibbs free energy. It is concluded that the affinity of the antibiotics penicillin and cephalosporin may in the future represent an obstacle for the treatment of diseases such as, mild and moderate infections of the respiratory tract, skin infections, venereal infections, and the prophylaxis of rheumatic diseases. We suggest that further studies evaluate the simulations with molecular dynamics tests to see if, considering the flexibility of the enzyme, even more accurate results would be possible.

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Does Cephalosporin Skin Test Predict Immediate Hypersensitivity to Cephalosporin?

Abstract: ► See the article "Results of Intradermal Skin Testing with Cefazolin according to a History of Hypersensitivity to Antibiotics" in volume 34, number 50, e319.

Cited by 3 publications

References 6 publications

Potential Factors of Primary Hospital Healthcare Professionals in Hindering the Abolition of Routine Skin Test for Cephalosporin: A Cross-Sectional Study

Potential Factors of Primary Hospital Healthcare Professionals in Hindering the Abolition of Routine Skin Test for Cephalosporin: A Cross-Sectional Study

Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis

Estudo da enzima beta-lactamase e sua relação com a resistência aos antibióticos

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