Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-05-26T14:53:33.088Z Has data issue: false hasContentIssue false
  • English
  • Français

Perioperative cefazolin prescribing rates following suppression of alerts for non-IgE-mediated penicillin allergies

Published online by Cambridge University Press:  09 May 2024

Ashley Bogus Open the ORCID record for Ashley Bogus [Opens in a new window] ,
Kelley McGinnis ,
Joshua Vergin ,
Sara M. May ,
Richard J. Hankins Open the ORCID record for Richard J. Hankins [Opens in a new window] ,
Erica Stohs ,
Trevor C. Van Schooneveld Open the ORCID record for Trevor C. Van Schooneveld [Opens in a new window]  and
Scott J. Bergman Open the ORCID record for Scott J. Bergman [Opens in a new window]
Ashley Bogus*
Affiliation:
Nebraska Medicine, Omaha, NE, USA
Kelley McGinnis
Affiliation:
Nebraska Medicine, Omaha, NE, USA
Joshua Vergin
Affiliation:
University of Nebraska Medical Center College of Pharmacy, Omaha, NE, USA
Sara M. May
Affiliation:
Nebraska Medicine, Omaha, NE, USA University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
Richard J. Hankins
Affiliation:
Nebraska Medicine, Omaha, NE, USA University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
Erica Stohs
Affiliation:
Nebraska Medicine, Omaha, NE, USA University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
Trevor C. Van Schooneveld
Affiliation:
Nebraska Medicine, Omaha, NE, USA University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
Scott J. Bergman
Affiliation:
Nebraska Medicine, Omaha, NE, USA University of Nebraska Medical Center College of Pharmacy, Omaha, NE, USA
*
Corresponding author: Ashley Bogus, PharmD; Email: ashleybogus@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Cefazolin is the preferred antimicrobial for the prevention of surgical site infections (SSIs) in many procedures. The presence of penicillin allergies can influence prescribing of alternative agents like vancomycin. In April 2022, Nebraska Medicine implemented a suppression of alerts for non-IgE-mediated and nonsevere penicillin allergies in the electronic medical record (EMR) upon cephalosporin prescribing. The objective of this study was to evaluate changes in perioperative cefazolin for SSI prophylaxis.

Methods:

This was a quasi-experimental study of patients undergoing procedures for which cefazolin was the preferred agent per institutional guidance. Education on the change was distributed via e-mail to surgical staff and pharmacists. Pre- and post-intervention data were collected from April 2021 through March 2022 and April 11, 2022, through October 2022, respectively. Chart review was performed on patients with reported penicillin allergies for the top surgical procedures with <50% cefazolin utilization pre-intervention. The primary outcome was the administration of perioperative cefazolin in patients with penicillin allergies, including unknown reactions.

Results:

A total of 6,676 patients underwent surgical procedures (pre-intervention n = 4,147, post-intervention n = 2,529). Documented penicillin allergies were similar between the pre- and post-intervention group (12.3% vs. 12.6%). In individuals with documented penicillin allergies, cefazolin prescribing increased from 49.6% to 74.3% (p < 0.01). Chart review for safety outcomes identified no difference in new severe reactions, rescue medication, SSIs, acute kidney injury, postoperative Clostridioides difficile infection, or methicillin-resistant Staphylococcus aureus infections.

Conclusion:

Following the suppression of EMR alerts for non-IgE-mediated and nonsevere penicillin allergies, cefazolin prescribing rates for SSI prophylaxis significantly improved.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 5
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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(3):195–283. doi: 10.2146/ajhp120568.CrossRefGoogle ScholarPubMed
Alexander, JW, Solomkin, JS, Edwards, MJ. Updated recommendations for control of surgical site infections. Ann Surg. 2011;253(6):1082–1093. doi: 10.1097/SLA.0b013e31821175f8.CrossRefGoogle ScholarPubMed
Jeffres, MN, Narayanan, PP, Shuster, JE, Schramm, GE. Consequences of avoiding β-lactams in patients with β-lactam allergies. J Allergy Clin Immunol. 2016;137(4):1148–1153. doi: 10.1016/j.jaci.2015.10.026.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(3):329–336. doi: 10.1093/cid/cix794.CrossRefGoogle ScholarPubMed
Chiriac, AM, Banerji, A, Gruchalla, RS, et al. Controversies in drug allergy: drug allergy pathways. J Allergy Clin Immunol Pract. 2019;7(1):46–60.e4. doi: 10.1016/j.jaip.2018.07.037.CrossRefGoogle ScholarPubMed
Macy, E, Contreras, R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol. 2014;133(3):790–796. doi: 10.1016/j.jaci.2013.09.021.CrossRefGoogle ScholarPubMed
Thayer, A, Smith, K, Clark, D, Hawkins, R, Stogsdill, P, Rokas, K. Cefazolin-based antimicrobial prophylaxis may reduce surgical site infections in patients undergoing peripheral vascular bypass surgery. Open Forum Infect Dis. 2016;3(suppl_1). doi: 10.1093/ofid/ofw172.1169.CrossRefGoogle Scholar
Hawn, MT, Richman, JS, Vick, CC, et al. Timing of surgical antibiotic prophylaxis and the risk of surgical site infection. JAMA Surg. 2013;148(7):649. doi: 10.1001/jamasurg.2013.134.CrossRefGoogle ScholarPubMed
Tice, AD, Rehm, SJ, Dalovisio, JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2004;38(12):1651–1671. doi: 10.1086/420939.CrossRefGoogle ScholarPubMed
Baxter, R, Ray, GT, Fireman, BH. Case-control study of antibiotic use and subsequent Clostridium difficile—associated Diarrhea in hospitalized patients. Infect Control Hosp Epidemiol. 2008;29(1):44–50. doi: 10.1086/524320.CrossRefGoogle ScholarPubMed
Sagar, PS, Katelaris, CH. Utility of penicillin allergy testing in patients presenting with a history of penicillin allergy. Asia Pac Allergy. 2013;3(2):115–119. doi: 10.5415/apallergy.2013.3.2.115.CrossRefGoogle ScholarPubMed
Macy, E, Ngor, EW. Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin, and oral amoxicillin. J Allergy Clin Immunol Pract. 2013;1(3):258–263. doi: 10.1016/j.jaip.2013.02.002.CrossRefGoogle ScholarPubMed
Castells, M, Khan, DA, Phillips, EJ. Penicillin allergy. N Engl J Med. 2019;381(24):2338–2351. doi: 10.1056/NEJMra1807761.CrossRefGoogle ScholarPubMed
Vyles, D, Mistry, RD, Heffner, V, et al. Reported knowledge and management of potential penicillin allergy in children. Acad Pediatr. 2019;19(6):684–690. doi: 10.1016/j.acap.2019.01.002.CrossRefGoogle ScholarPubMed
Vorobeichik, L, Weber, EA, Tarshis, J. Misconceptions surrounding penicillin allergy. Anesth Analg. 2018;127(3):642–649. doi: 10.1213/ANE.0000000000003419.CrossRefGoogle ScholarPubMed
Sousa-Pinto, B, Blumenthal, KG, Courtney, L, Mancini, CM, Jeffres, MN. Assessment of the frequency of dual allergy to Penicillins and Cefazolin. JAMA Surg. 2021;156(4):e210021. doi: 10.1001/jamasurg.2021.0021.CrossRefGoogle ScholarPubMed
Anstey, KM, Anstey, JE, Doernberg, SB, Chen, LL, Otani, IM. Perioperative use and safety of cephalosporin antibiotics in patients with documented penicillin allergy. J Allergy Clin Immunol Pract. 2021;9(8):3203–3207.e1. doi: 10.1016/j.jaip.2021.03.017.CrossRefGoogle ScholarPubMed
Macy, E, McCormick, TA, Adams, JL, et al. Association between removal of a warning against cephalosporin use in patients with penicillin allergy and antibiotic prescribing. JAMA Netw Open. 2021;4(4):e218367. doi: 10.1001/jamanetworkopen.2021.8367.CrossRefGoogle ScholarPubMed
Boesch, TS, Eischen, E, Ries, AM, Quinn, A, Dave, A, Beezhold, DW. Promoting β-lactam utilization through suppression of electronic medical record cross-allergy alerts. Am J Health Syst Pharm. 2022;79(Supplement_2):S43–S52. doi: 10.1093/ajhp/zxac040.CrossRefGoogle ScholarPubMed