Reported Penicillin Allergy Increases Risk of Surgical Site Infections

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Appropriate use of perioperative antibiotics can decrease the incidence of surgical site infections.
Appropriate use of perioperative antibiotics can decrease the incidence of surgical site infections.

Patients who reported a penicillin allergy were shown to have a 50% increased risk for surgical site infections, according to the results of a study published in Clinical Infectious Diseases.

In this retrospective cohort study, 8385 patients who had undergone 9004 common surgical procedures (hip arthroplasty, knee arthroplasty, hysterectomy, colon surgery, or coronary artery bypass grafting) were evaluated. The incidence of surgical site infections and perioperative antibiotic use were compared between patients with reported penicillin allergies (n = 922, 11%) and those without reported penicillin allergies (n = 7463, 89%).

A total of 241 surgical site infections were reported (2.7%). Patients who reported a penicillin allergy were at higher risk for surgical site infections (adjusted odds ratio 1.51; 95% CI, 1.02-2.22).

Compared with patients who did not report a penicillin allergy, those who did were less likely to receive cefazolin (12% vs 92%, P <.001) and more likely to receive clindamycin (49% vs 3%; P <.001), vancomycin (35% vs 3%, P <.001), or gentamicin (24% vs 3%, P <.001). According to the study authors, the increased risk for surgical site infections among patients with reported penicillin allergies could be attributed to the receipt of second-line antibiotics.

The number needed to evaluate to prevent 1 surgical site infection was shown to be between 112 and 124.

In an interview with Infectious Disease Advisor, Kimberly G Blumenthal, MD, of the Division of Rheumatology, Allergy, and Immunology, Department of Medicine, at Massachusetts General Hospital in Boston, and lead author on the paper, concluded, “Considering the morbidity of surgical site infections and modest resources needed to clarify the allergy, I recommend penicillin allergy evaluation in some form in advance of surgical procedures to increase the chances of getting the recommended antibiotic.”

Reference

Blumenthal KG, Ryan ER, Li Y, Lee H, Kuhlen JL, Shenoy ES. The impact of a reported penicillin allergy on surgical site infection risk [published online October 9, 2017]. Clin Infect Dis. doi: 10.1093/cid/cix794

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