Impact of a Pharmacist-Driven Penicillin Allergy De-Labeling Pilot Program in Preoperative Cardiothoracic and Spine Surgery Patients at a Quaternary Hospital

Abstract

Documented penicillin allergies are associated with an increased risk of surgical site infections (SSIs), and first-line antibiotics (e.g., cefazolin) are associated with a lower risk of SSIs. The goal of this study was to evaluate the effect of a pharmacist-driven penicillin allergy de-labeling pilot program on the use of preoperative cefazolin in selected surgery patients with documented penicillin allergies. This single-center, quasi-experimental study included adult patients with a charted penicillin allergy who underwent CT or spine surgery in 2021 (control group) or during the 6-month intervention pilot (October 2022–March 2023). In the intervention group, qualifying patients were interviewed via phone to assess allergy history. Qualified patients were de-labeled or referred to an allergist for outpatient skin testing and/or oral challenge. The primary outcome was the rate of cefazolin use preoperatively. Secondary outcomes included 30-day SSIs, Clostridioides difficile infection, acute kidney injury, readmission, and hospital length of stay. Of the intervention group, 57 (79.2%) patients completed the interview. Cefazolin was used preoperatively in 71.0% (152) of the control group versus 88.9% (64) of the intervention group (p < 0.002). There were no clinically significant differences in secondary outcomes. The pharmacist-driven penicillin allergy de-labeling pilot program in CT and spine surgery patients was associated with increased cefazolin use.