Deanna L McDanel1, Antoine E Azar2, Amy M Dowden3, Samantha Murray-Bainer4, Nicolas O Noiseux5, Melissa Willenborg5, Charles R Clark5, John J Callaghan5, Ambar Haleem6. 1. Department of Pharmaceutical Care, University of Iowa Healthcare, Iowa City, Iowa; University of Iowa College of Pharmacy, Iowa City, Iowa. 2. University of Iowa Carver College of Medicine, Iowa City, Iowa; University of Iowa Healthcare, Iowa City, Iowa; Johns Hopkins University, Baltimore, Maryland. 3. University of Iowa Carver College of Medicine, Iowa City, Iowa; University of Iowa Healthcare, Iowa City, Iowa. 4. University of Iowa Carver College of Medicine, Iowa City, Iowa; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin. 5. Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa. 6. University of Iowa Carver College of Medicine, Iowa City, Iowa; Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa; Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin.
Abstract
BACKGROUND: The reliability of patient-reported penicillin allergies has been disputed. A Drug Allergy Clinic (DAC) was established at our institution in combination with an electronic best practice alert (BPA) in the Orthopedic Clinic. Joint arthroplasty patients with a reported history of beta-lactam allergy (HOBA) were preoperatively referred via the BPA to the DAC. The purpose of this study was to determine the effectiveness of beta-lactam allergy screening in enabling the surgical team to optimize antimicrobial prophylaxis. METHODS: Between February 2013 and May 2015, 161 patients with a HOBA were referred to the DAC where they underwent penicillin skin testing (PST), a drug challenge to a beta-lactam antibiotic, and/or had no intervention depending on the history obtained. RESULTS: PST was performed on 140 of 161 (87%) patients. A negative PST was noted in 139 (99%) patients, indicating no penicillin allergy. Cefazolin was safe to use in 145 (90%) patients evaluated. Significantly more patients evaluated in the DAC vs those not seen got cefazolin in any surgical prophylaxis regimen (90% vs 77%) without any adverse perioperative reactions. Concurrently, the use of non-beta-lactam antibiotics was significantly less in the patients evaluated vs not evaluated (16% vs 27%). The overall use of cefazolin in orthopedic surgeries in patients with HOBA was >84% over the course of the study period. CONCLUSION: Beta-lactam allergy screening using a BPA and a DAC promotes the use of standard surgical prophylaxis with cefazolin. Joint arthroplasty surgeons should consider implementing allergy screening programs to promote antimicrobial stewardship.
BACKGROUND: The reliability of patient-reported penicillinallergies has been disputed. A Drug Allergy Clinic (DAC) was established at our institution in combination with an electronic best practice alert (BPA) in the Orthopedic Clinic. Joint arthroplasty patients with a reported history of beta-lactamallergy (HOBA) were preoperatively referred via the BPA to the DAC. The purpose of this study was to determine the effectiveness of beta-lactamallergy screening in enabling the surgical team to optimize antimicrobial prophylaxis. METHODS: Between February 2013 and May 2015, 161 patients with a HOBA were referred to the DAC where they underwent penicillin skin testing (PST), a drug challenge to a beta-lactam antibiotic, and/or had no intervention depending on the history obtained. RESULTS: PST was performed on 140 of 161 (87%) patients. A negative PST was noted in 139 (99%) patients, indicating no penicillinallergy. Cefazolin was safe to use in 145 (90%) patients evaluated. Significantly more patients evaluated in the DAC vs those not seen got cefazolin in any surgical prophylaxis regimen (90% vs 77%) without any adverse perioperative reactions. Concurrently, the use of non-beta-lactam antibiotics was significantly less in the patients evaluated vs not evaluated (16% vs 27%). The overall use of cefazolin in orthopedic surgeries in patients with HOBA was >84% over the course of the study period. CONCLUSION:Beta-lactamallergy screening using a BPA and a DAC promotes the use of standard surgical prophylaxis with cefazolin. Joint arthroplasty surgeons should consider implementing allergy screening programs to promote antimicrobial stewardship.
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