Jennifer M Grant1, Wendy H C Song2, Salomeh Shajari3, Raymond Mak4, Andrew T Meikle5, Nilufar Partovi6, Bassam A Masri7, Tim T Y Lau8. 1. ASPIRES (Antimicrobial Stewardship Programme), Medicine Quality and Safety, Vancouver Coastal Health, Vancouver, BC, Canada; Divisions of Medical Microbiology and Infection Control, and Infectious Diseases, Vancouver Coastal Health, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Division of Medical Microbiology, Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada. 2. Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada. 3. ASPIRES (Antimicrobial Stewardship Programme), Medicine Quality and Safety, Vancouver Coastal Health, Vancouver, BC, Canada. 4. Division of Allergy and Immunology, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada. 5. Department of Anesthesiology and Perioperative Care, Vancouver General Hospital and UBC Hospital, Vancouver Coastal Health, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada. 6. Pharmaceutical Sciences, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada. Electronic address: https://twitter.com/nikepartair. 7. Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada. Electronic address: https://twitter.com/Bas_Vancouver. 8. ASPIRES (Antimicrobial Stewardship Programme), Medicine Quality and Safety, Vancouver Coastal Health, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Pharmaceutical Sciences, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada. Electronic address: Tim.Lau@vch.ca.
Abstract
BACKGROUND: Cefazolin surgical prophylaxis is associated with better patient outcomes; however, its use in penicillin-allergic patients is controversial. We evaluated the safety of cefazolin as surgical prophylaxis in penicillin-allergic patients, including those with anaphylaxis histories. METHODS: We conducted a pre and postintervention quality improvement evaluation of an institution-wide policy change at a tertiary-care hospital, before (October 2017-January 2018), during (February 2018-September 2018), and after (October 2018-October 2019) transition to routine cefazolin prophylaxis for penicillin-allergic patients, including those with anaphylaxis histories but excluding severe delayed reactions (eg, Stevens-Johnson syndrome). Retrospective data was collected on all surgical prophylaxis patients with penicillin-anaphylactic histories between October 2017 and September 2018. From October 2018, we prospectively reviewed adverse events with cefazolin. Primary outcome was adverse events in penicillin-allergic patients receiving cefazolin perioperatively. RESULTS: From October 2017 to October 2019, 27,467 operations were performed. Of 220 patients with penicillin-anaphylactic histories reviewed prior to the full policy change, no statistically significant differences were reported in allergic reactions (P = .70), surgical site infections (P = 1.00), or adverse events (P = .32) with cefazolin compared to other antibiotics. Postpolicy implementation, cefazolin usage increased 18.2%, while vancomycin and clindamycin decreased by 11.4% and 62.0%, respectively. No anaphylaxis was documented in penicillin-allergic patients receiving cefazolin in either the review or quality assurance follow-up after the change. Of 3 patients developing reactions to cefazolin, none had histories of penicillin allergy. Surgical site infection rates were similar between pre and postpolicy time periods (P = .842). CONCLUSION: Administration of cefazolin in penicillin-anaphylactic patients for surgical prophylaxis appears to be safe.
BACKGROUND:Cefazolin surgical prophylaxis is associated with better patient outcomes; however, its use in penicillin-allergicpatients is controversial. We evaluated the safety of cefazolin as surgical prophylaxis in penicillin-allergicpatients, including those with anaphylaxis histories. METHODS: We conducted a pre and postintervention quality improvement evaluation of an institution-wide policy change at a tertiary-care hospital, before (October 2017-January 2018), during (February 2018-September 2018), and after (October 2018-October 2019) transition to routine cefazolin prophylaxis for penicillin-allergicpatients, including those with anaphylaxis histories but excluding severe delayed reactions (eg, Stevens-Johnson syndrome). Retrospective data was collected on all surgical prophylaxis patients with penicillin-anaphylactic histories between October 2017 and September 2018. From October 2018, we prospectively reviewed adverse events with cefazolin. Primary outcome was adverse events in penicillin-allergicpatients receiving cefazolin perioperatively. RESULTS: From October 2017 to October 2019, 27,467 operations were performed. Of 220 patients with penicillin-anaphylactic histories reviewed prior to the full policy change, no statistically significant differences were reported in allergic reactions (P = .70), surgical site infections (P = 1.00), or adverse events (P = .32) with cefazolin compared to other antibiotics. Postpolicy implementation, cefazolin usage increased 18.2%, while vancomycin and clindamycin decreased by 11.4% and 62.0%, respectively. No anaphylaxis was documented in penicillin-allergicpatients receiving cefazolin in either the review or quality assurance follow-up after the change. Of 3 patients developing reactions to cefazolin, none had histories of penicillinallergy. Surgical site infection rates were similar between pre and postpolicy time periods (P = .842). CONCLUSION: Administration of cefazolin in penicillin-anaphylactic patients for surgical prophylaxis appears to be safe.
Authors: Rebecca E Berger; Harjot K Singh; Angela S Loo; Victoria Cooley; Snezana Nena Osorio; Jennifer I Lee; Matthew S Simon Journal: Jt Comm J Qual Patient Saf Date: 2021-12-09