Merin Kuruvilla1, Marybeth Sexton2, Zanthia Wiley2, Terry Langfitt3, Grant C Lynde3, Francis Wolf3. 1. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, Ga. Electronic address: merin.kuruvilla@emoryhealthcare.org. 2. Division of Infectious Diseases, Atlanta, Ga. 3. Department of Anesthesiology, Emory University School of Medicine, Atlanta, Ga.
Abstract
BACKGROUND: Patients with penicillin allergy labels often receive alternative antibiotics for perioperative prophylaxis, as opposed to first-line cephalosporins (cefazolin/cefuroxime). Provider misconceptions about the risk of cross-reactivity likely drive this prescribing behavior, which is problematic because of its association with increased risk of surgical-site infections. OBJECTIVE: To develop, implement, and assess the safety of a streamlined approach to perioperative antibiotic selection for surgical patients with a penicillin allergy label, to reduce the use of second-line antibiotics. METHODS: A multidisciplinary task force developed an institutional algorithm for antibiotic selection in penicillin-allergic surgical patients. The percentage of patients receiving a first-line cephalosporin was compared before and after algorithm utilization. The safety of this approach was assessed via chart review of all patients who received epinephrine or diphenhydramine in the operating room, or diphenhydramine within 24 hours postoperatively, assessing for any adverse reactions to cephalosporin administration. RESULTS: Between September 2016 and May 2019, 9.3% of surgical patients had documented penicillin allergy (n = 2296). At baseline, 22% of these patients received a cephalosporin, with an increase to more than 80% after algorithm implementation (P < .0001). Among 551 patients with penicillin allergy label who received a cephalosporin after algorithm implementation, no immediate allergic reactions requiring epinephrine were identified; 1 patient had a delayed rash that did not require cephalosporin discontinuation. Three patients received diphenhydramine for "itching" without rash in the setting of concomitant narcotic administration. CONCLUSIONS: Using a streamlined algorithm, we were able to significantly reduce the use of second-line antibiotics in penicillin-allergic surgical patients without severe adverse reactions.
BACKGROUND:Patients with penicillinallergy labels often receive alternative antibiotics for perioperative prophylaxis, as opposed to first-line cephalosporins (cefazolin/cefuroxime). Provider misconceptions about the risk of cross-reactivity likely drive this prescribing behavior, which is problematic because of its association with increased risk of surgical-site infections. OBJECTIVE: To develop, implement, and assess the safety of a streamlined approach to perioperative antibiotic selection for surgical patients with a penicillinallergy label, to reduce the use of second-line antibiotics. METHODS: A multidisciplinary task force developed an institutional algorithm for antibiotic selection in penicillin-allergic surgical patients. The percentage of patients receiving a first-line cephalosporin was compared before and after algorithm utilization. The safety of this approach was assessed via chart review of all patients who received epinephrine or diphenhydramine in the operating room, or diphenhydramine within 24 hours postoperatively, assessing for any adverse reactions to cephalosporin administration. RESULTS: Between September 2016 and May 2019, 9.3% of surgical patients had documented penicillinallergy (n = 2296). At baseline, 22% of these patients received a cephalosporin, with an increase to more than 80% after algorithm implementation (P < .0001). Among 551 patients with penicillinallergy label who received a cephalosporin after algorithm implementation, no immediate allergic reactions requiring epinephrine were identified; 1 patient had a delayed rash that did not require cephalosporin discontinuation. Three patients received diphenhydramine for "itching" without rash in the setting of concomitant narcotic administration. CONCLUSIONS: Using a streamlined algorithm, we were able to significantly reduce the use of second-line antibiotics in penicillin-allergic surgical patients without severe adverse reactions.
Authors: Jocelyn J Cooper; Vidya L Atluri; Rupali Jain; Paul S Pottinger; David T Coleman Journal: Ann Allergy Asthma Immunol Date: 2022-03-24 Impact factor: 6.248
Authors: Raquel Jones; Katelyn S Quartuccio; Jessica L Stern; Eric V Heintz; Kelly E Pillinger; Thomas G Myers Journal: Clin Orthop Relat Res Date: 2021-07-01 Impact factor: 4.755