Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-06-11T20:57:07.417Z Has data issue: false hasContentIssue false
  • English
  • Français

Self-reported beta-lactam allergy and the risk of surgical site infection: A retrospective cohort study

Published online by Cambridge University Press:  23 January 2020

Philip W. Lam Open the ORCID record for Philip W. Lam [Opens in a new window] ,
Payam Tarighi ,
Marion Elligsen ,
Keith Gunaratne ,
Avery B. Nathens ,
Jordan Tarshis  and
Jerome A. Leis
Philip W. Lam*
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Payam Tarighi
Affiliation:
Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Marion Elligsen
Affiliation:
Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Keith Gunaratne
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Avery B. Nathens
Affiliation:
Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Jordan Tarshis
Affiliation:
Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Jerome A. Leis
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Philip Lam, E-mail: philip.lam@sunnybrook.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess whether a self-reported β-lactam allergy is associated with an increased risk of surgical site infection (SSI) across a broad range of procedures and to determine whether this association is mediated by the receipt of an alternate antibiotic to cefazolin.

Design:

Retrospective cohort study.

Participants:

Surgical procedures sampled by an institutional National Surgical Quality Improvement Program database over an 18-month period (January 2017 to June 2018) from 7 surgical specialties.

Setting:

Tertiary-care academic hospital.

Results:

Of the 3,589 surgical procedures included in the study, 369 (10.3%) were performed in patients with a reported β-lactam allergy. Those with a reported β-lactam allergy were significantly less likely to receive cefazolin (38.8% vs 95.5%) or metronidazole (20.3% vs 26.1%) and were more likely to receive clindamycin (52.0% vs 0.2%), gentamicin (3.5% vs 0%), or vancomycin (2.2% vs 0.1%) than those without allergy. An SSI occurred in 154 of 3,220 procedures (4.8%) in patients without reported allergy and 27 of 369 (7.3%) with reported allergy. In the multivariable regression model, a reported β-lactam allergy was associated with a statistically significant increase in SSI risk (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.04–2.51; P = .03). This effect was completely mediated by receipt of an alternate antibiotic to cefazolin (indirect effect aOR, 1.68; 95% CI, 1.17–2.34; P = .005).

Conclusions:

Self-reported β-lactam allergy was associated with an increased SSI risk mediated through receipt of alternate antibiotic prophylaxis. Safely increasing use of cefazolin prophylaxis in patients with reported β-lactam allergy can potentially lower the risk of SSIs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 4 , April 2020 , pp. 438 - 443
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bratzler, DW, Dellinger, EP, Olsen, KM, et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195–283.CrossRefGoogle ScholarPubMed
Zagursky, RJ, Pichichero, ME.Cross-reactivity in β-lactam allergy. J Allergy Clin Immunol Pract 2018;6:72–81.CrossRefGoogle ScholarPubMed
MacFadden, DR, LaDelfa, A, Leen, J, et al.Impact of reported beta-lactam allergy on inpatient outcomes: a multicenter prospective cohort study. Clin Infect Dis 2016;63:904–910.CrossRefGoogle ScholarPubMed
Macy, E, Contreras, R.Healthcare use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol 2014;133:790–796.CrossRefGoogle ScholarPubMed
Huang, KG, Cluzet, V, Hamilton, K, Fadugba, O.The impact of reported beta-lactam allergy in hospitalized patients with hematologic malignancies requiring antibiotics. Clin Infect Dis 2018;67:27–33.CrossRefGoogle ScholarPubMed
Blumenthal, KG, Ryan, EE, Li, Y, Lee, H, Kuhlen, JL, Shenoy, ES.The impact of a reported penicillin allergy on surgical site infection risk. Clin Infect Dis 2018;66:329–336.CrossRefGoogle ScholarPubMed
American College of Surgeons User Guide for the 2017. ACS NSQIP Participant use data file (PUF). American College of Surgeons website. https://www.facs.org/-/media/files/quality-programs/nsqip/nsqip_puf_userguide_2017.ashx?la=en. Published 2018. Accessed July 22, 2019.Google Scholar
Elligsen, M.Prospective audit and feedback of antimicrobial stewardship in critical care: program implementation, experience, and challenges. Can J Hosp Pharm 2012;65:31–36.Google ScholarPubMed
Protocol for definition of surgical site infection. Centers for Disease Control (CDC)/National Healthcare Safety Network (NHSN). https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Published 2019. Accessed June 24, 2019.Google Scholar
Blumenthal, KG, Peter, JG, Trubiano, JA, Phillips, EJ.Antibiotic allergy. Lancet 2019;393:183–198.CrossRefGoogle ScholarPubMed
Owens, CD, Stoessel, K.Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect 2008;70:3–10.CrossRefGoogle ScholarPubMed
Steen, J, Loeys, T, Moerkerke, B, Vansteelandt, S.medflex: an R package for flexible mediation analysis using natural effect models. J Stat Softw 2017;76:1–46.CrossRefGoogle Scholar
Vorobeichik, L, Weber, EA, Tarshis, J.Misconceptions surrounding penicillin allergy: implications for anesthesiologists. Anesth Analg 2018;127:642–649.CrossRefGoogle ScholarPubMed
Li, JT, Markus, PJ, Osmon, DR, Estes, L, Gosselin, VA, Hanssen, AD.Reduction of vancomycin use in orthopedic patients with a history of antibiotic allergy. Mayo Clin Proc 2000;75:902–906.CrossRefGoogle ScholarPubMed
Park, M, Marku, P, Matesic, D, Li, JT.Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy. Ann Allergy Asthma Immunol 2006;97:681–687.CrossRefGoogle ScholarPubMed
Frigas, E, Mark, MA, Narr, BJ.Preoperative evaluation of patients with history of allergy to penicillin: comparison of 2 models of practice. Mayo Clin Proc 2008; 83: 651–62.CrossRefGoogle ScholarPubMed
Cook, DJ, Barbara, DW, Singh, KE, Dearani, JA.Penicillin skin testing in cardiac surgery. J Thorac Cardiovasc Surg 2014;147:1931–1935.CrossRefGoogle ScholarPubMed
McDanel, DL, Azar, AE, Dowden, AM.Screening for beta-lactam allergy in joint arthroplasty patients to improve surgical prophylaxis practice. J Arthroplasty 2017;32:S101–S108.CrossRefGoogle ScholarPubMed
Moussa, Y, Shuster, J, Matte, G, et al.Delabeling of β-lactam allergy reduces intraoperative time and optimizes choice in antibiotic prophylaxis. Surgery (in press). 2018. pii: S0039-6060(18)30127-2. doi: 10.1016/j.surg.2018.03.004.CrossRefGoogle Scholar
Savic, L, Gurr, L, Kaura, V, et al.Penicillin allergy de-labelling ahead of elective surgery: feasibility and barriers. Br J Anaesth 2019;123:e110–e116.CrossRefGoogle ScholarPubMed
Leis, JA, Palmay, L, Ho, G, et al.Point-of-care β-lactam allergy skin testing by antimicrobial stewardship programs: a pragmatic multicenter prospective evaluation. Clin Infect Dis 2017;65:1059–1065.CrossRefGoogle ScholarPubMed
Supplementary material: File

Lam et al. supplementary material

Lam et al. supplementary material

Download Lam et al. supplementary material(File)
File 29.2 KB