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The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2018 Jan 18; Vol. 66 (3), pp. 329-336. - Publication Year :
- 2018
-
Abstract
- Background: A reported penicillin allergy may compromise receipt of recommended antibiotic prophylaxis intended to prevent surgical site infections (SSIs). Most patients with a reported penicillin allergy are not allergic. We determined the impact of a reported penicillin allergy on the development of SSIs.<br />Methods: In this retrospective cohort study of Massachusetts General Hospital hip arthroplasty, knee arthroplasty, hysterectomy, colon surgery, and coronary artery bypass grafting patients from 2010 to 2014, we compared patients with and without a reported penicillin allergy. The primary outcome was an SSI, as defined by the Centers for Disease Control and Prevention's National Healthcare Safety Network. The secondary outcome was perioperative antibiotic use.<br />Results: Of 8385 patients who underwent 9004 procedures, 922 (11%) reported a penicillin allergy, and 241 (2.7%) had an SSI. In multivariable logistic regression, patients reporting a penicillin allergy had increased odds (adjusted odds ratio, 1.51; 95% confidence interval, 1.02-2.22) of SSI. Penicillin allergy reporters were administered less cefazolin (12% vs 92%; P < .001) and more clindamycin (49% vs 3%; P < .001), vancomycin (35% vs 3%; P < .001), and gentamicin (24% vs 3%; P < .001) compared with those without a reported penicillin allergy. The increased SSI risk was entirely mediated by the patients' receipt of an alternative perioperative antibiotic; between 112 and 124 patients with reported penicillin allergy would need allergy evaluation to prevent 1 SSI.<br />Conclusions: Patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of second-line perioperative antibiotics. Clarification of penicillin allergies as part of routine preoperative care may decrease SSI risk.<br /> (© The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Subjects :
- Aged
Anti-Bacterial Agents adverse effects
Arthroplasty, Replacement, Hip adverse effects
Arthroplasty, Replacement, Knee adverse effects
Clindamycin therapeutic use
Cross Infection drug therapy
Cross Infection prevention & control
Female
Humans
Male
Massachusetts
Middle Aged
Odds Ratio
Retrospective Studies
Risk Factors
Surgical Wound Infection drug therapy
Vancomycin therapeutic use
Anti-Bacterial Agents therapeutic use
Antibiotic Prophylaxis statistics & numerical data
Drug Hypersensitivity complications
Penicillins adverse effects
Surgical Wound Infection prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 66
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 29361015
- Full Text :
- https://doi.org/10.1093/cid/cix794