Penicillin allergy labels drive perioperative prophylactic antibiotic selection in orthopedic procedures

Abstract

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Advances in immunoglobulin E mediated antibiotic allergy

“…Another area of risk stratification is utilization of cefazolin for preoperative prophylaxis for patients with PALs. Preoperative antibiotic selection is negatively impacted by unevaluated PALs and can increase the risk of surgical site infections [29,30]. It has been demonstrated through implementation of education and changing hospital procedures for selection of surgical prophylactic antibiotics, that even those with a history of a potential IgE mediated reaction to penicillin receive and tolerate cefazolin (whose R1 side chain is not shared by any other penicillin or cephalosporin in the United States) [31][32][33][34][35][36][37].…”

Prevention of surgical site infection: a ten-step approach

“…Due to their relatively benign risk profile and broad-spectrum antimicrobial activity, recent CPGs have endorsed the use of either first or second-generation cephalosporins as the primary method of antibiotic prophylaxis in this setting [ 25 ]. Although surgeons have traditionally been discouraged from administering cephalosporins in patients with self-reported penicillin allergies, we now know that cross-reactivity between cephalosporins and penicillin is uncommon [ 26 ]. Furthermore, in the absence of a documented history of an anaphylactic reaction to penicillin, self-reported penicillin allergies are often inconsequential, making cephalosporins a safe and practical option in these patients [ 27 ].…”

Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting

“…3 In orthopaedic surgery, a PAL is the primary driver for choosing an alternative perioperative antibiotic, with clindamycin being used most frequently (Odds Ratio [OR] 34.6, 95% Confidence Interval [CI] 29.9 to 30.1, P , 0.005). 4 The use of these second-line antibiotics leads to increased healthcare-associated infections, including a 23% increased odds of Clostridium difficile, a 14% increased odds of methicillin-resistant Staphylococcus aureus, and a 30% increased odds of vancomycin-resistant Enterococcus. [5][6][7] In another multisite, prospective cohort study, beta-lactam allergic patients who received a nonbeta-lactam antibiotic as opposed to a beta-lactam antibiotic had markedly more adverse events reported in the form of hospital readmissions for the same infection, acute kidney injury, C difficile, or other drug-related events (OR 3.2, 95% CI 1.28 to 7.89).…”