Infectious Disease

The documented beta-lactam allergy will increase the chance of riskier antibiotics for surgical prophylaxis

December 11, 2020

2 min read

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Disclosure:
Blumenthal reports on a clinical decision support tool for beta-lactam allergies that is licensed to Persistent Systems.

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Surgical patients with documented beta-lactam allergy were nine times less likely to receive the preferred first-line antibiotic cefazolin, but riskier alternative antibiotics, according to a recent study.

“The administration of antibiotics perioperatively is a common strategy for preventing infection of the surgical site.” Kimberly G. Blumenthal, MD, MSc, The allergy quality and safety officer at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School told Healio that it is usually at the surgeon’s discretion to select the antibiotic for prophylactic surgery. “Cefazolin is preferred for most surgical procedures because of its proven effectiveness. However, cefazolin is a beta-lactam antibiotic and can be avoided in patients with a reported allergy to beta-lactam antibiotics such as penicillin. “

Cefazolin infographic

Source: Bertram CM et al. Clin Infect Dis. 2020; doi: 10.1093 / cid / ciaa1762.

She added, “We wanted to find out if this was the case with a large sample of patients, as more than 95% of patients who report penicillin allergy are not actually allergic and cefazolin has little or possibly negligible cross-reactivity with penicillin having. ”

In order to evaluate the effects of a documented beta-lactam allergy on perioperative antibiotic selection, Blumenthal and colleagues carried out a national cross-sectional study with hospital patients through the Acute Care Hospital Group of Vichern Inc. According to the study, a representative from Vichern’s member hospitals conducted an admissions survey

This included hospital details and resources for evaluating beta-lactam allergies. The participating sites then submitted clinical details for inpatients treated with an antibiotic within the study period from October 16, 2018 to January 13, 2019, using electronic patient records and antibiotic use data.

One study showed that surgical inpatients with a documented beta-lactam allergy, despite the drug’s known risks, were nine times less likely to receive the preferred antibiotic for prophylaxis – cefazolin – and 45 times more likely to receive clindamycin.
Photo credit: Adobe Stock

A total of 1,632 surgical patients from 100 US hospitals were enrolled in the study. The researchers found that inpatient allergy consultations and 29 inpatient penicillin skin tests were available in 37 hospitals. In addition, almost all hospitals (96%) had a formalized antibiotic stewardship program.

The study showed that of the 1,632 patients who received antibiotics for surgical prophylaxis, 256 (16%) had a documented beta-lactam allergy, with 224 (88%) having a documented allergy to penicillin and 48 (19%) to cephalosporins had. According to the study, cefazolin was used less frequently in patients with a beta-lactam allergy than in those without one (28% versus 77%). Alternative antibiotics that were more commonly used in patients with documented beta-lactam allergy were vancomycin (24% versus 11%), fluoroquinolones (6% versus 2%), clindamycin (32% versus 1%), and gentamicin (11%) versus 3%)).

Kimberly G. Blumenthal

A fully fitted multivariable regression model showed that patients with a documented beta-lactam allergy were less likely to use cefazolin compared to patients without a documented beta-lactam allergy (adjusted OR = 0.11; 95% CI, 0 , 08-0.15). In addition, patients with a documented beta-lactam allergy were more likely to receive perioperative clindamycin (aOR = 45.6; 95% CI, 24.8-83.4) and were more likely to receive gentamicin (aOR = 3 , 9; 95% CI, 2.36-6.42). Fluoroquinolones (aOR = 3.11; 95% CI, 1.66-5.84) and vancomycin (aOR = 2.91; 95% CI, 2.05-4.13).

“This study shows the importance of including beta-lactam allergy assessments, which disprove reported beta-lactam allergies in more than 95% of patients, in preoperative care in order to guide the selection of antibiotics for surgical prophylaxis optimize, “said Blumenthal.

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