The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk

Blumenthal, Kimberly G.; Ryan, Erin; Liu, Yu; Lee, Hang; Kuhlen, James L.; Shenoy, Erica S.

doi:10.1093/ofid/ofx163.1723

Cited by 65 publications

(137 citation statements)

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“…The current investigation demonstrates, after adjusting for other risk factors associated with the development of CIEDI, vancomycin as SSI prophylaxis in patients undergoing either device placement or revision was associated with a threefold increased incidence of CIEDI as compared to that in patients who received beta-lactam antibiotic alone. These results are consistent with those seen in other types of surgical site infections 29,30 and, in part, are thought to be due to a decreased activity of vancomycin against MSSA, [23][24][25] which is a well-recognized pathogen of SSI that complicates surgical procedures involving the skin. Unfortunately, no microbiologic data were available in the VA system database to determine the contribution of MSSA to the increased SSI rate associated with prophylactic vancomycin use.…”

Section: Discussionsupporting

confidence: 87%

“…penicillin allergy had a 50% increased odds of SSI for a wide range of surgeries, most of whom received non-beta lactam surgical antibiotic prophylaxis including vancomycin or clindamycin. 30 Gupta et al also reported that vancomycin prophylaxis increased the risk of SSI in Veterans Affairs (VA) Boston patients with negative nasal MRSA test who underwent clean or clean-contaminated surgery. 31 Recognizing the current concerns regarding the use of vancomycin as SSI prophylaxis for surgical procedures that involve the skin, the current investigation was conducted to evaluate whether vancomycin as SSI prophylaxis increases the incidence of CIEDI as compared to betalactam antibiotics among a large Veterans Affairs Health System population who undergo CIED placement or revision.…”

Section: Blumenthal Et Al Recently Demonstrated That Patients With Rmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative antibiotics and cardiovascular implantable electronic device infection: A cohort study in veterans

Alzahrani

Liappis

Baddour

et al. 2018

Pacing Clinical Electrophis

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Section: Discussionsupporting

confidence: 87%

Section: Blumenthal Et Al Recently Demonstrated That Patients With Rmentioning

confidence: 99%

Preoperative antibiotics and cardiovascular implantable electronic device infection: A cohort study in veterans

Alzahrani

Liappis

Baddour

et al. 2018

Pacing Clinical Electrophis

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“…There is now sufficient evidence to conclude that use of alternative antimicrobials is likely the primary pathway by which the associated harm and expense of a penicillin allergy label is mediated to patients. 32,73,78,114,117 Therefore, the current practice of using alternative antimicrobials to work around penicillin allergy labels needs to be critically reassessed and modified to include risk stratification. When appropriate and available, a referral to an allergy specialist for testing and de-labeling, if appropriate, should be utilized, especially in cases where future use of antimicrobials is anticipated.…”

Section: Role Of Desensitization and Alternative Antibioticsmentioning

confidence: 99%

The challenge of de‐labeling penicillin allergy

Stone

Trubiano

Coleman

et al. 2019

Allergy

186

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Background Even though 8%‐25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy that has waned over time. Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de‐labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus. Methods We performed an evidence‐based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de‐labeling. Over the period 1928‐2018 in Pubmed and Medline, search terms used included “penicillin allergy” or “penicillin hypersensitivity” alone or in combination with “adverse events,” “testing,” “evaluation,” “effects,” “label,” “de‐labeling,” “prick or epicutaneous,” and “intradermal” skin testing, “oral challenge or provocation,” “cross‐reactivity,” and “antimicrobial stewardship”. Results Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance. Conclusions Operationalizing penicillin allergy de‐labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de‐labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs.

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“…Reported penicillin allergies have been associated with SSI in non-SOT recipients and are thought to reflect the use of non-beta-lactam antibiotics for SAP. (6) Although this small pilot study does not provide any insights about the association of penicillin allergies with SSI in LT recipients, we believe it is important to identify true penicillin allergies prior to LT.…”

Section: See Article On Page 1043mentioning

confidence: 89%