Post-Surgery Infections Can Be Prevented in Patients With Penicillin Allergy

The risk for surgical site infection (SSI) is approximately 50% higher among patients with a reported penicillin allergy who receive alternative perioperative antibiotics, according to a recent study.

Findings from the study were presented at ID Week, which took place from October 4 to 8, 2017, in San Diego, California.
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A reported penicillin allergy may interfere with surgical patients’ ability to receive recommended antibiotic prophylaxis for SSI prevention. However, most patients with a reported penicillin allergy are not actually allergic.

For their study, the researchers evaluated 8385 patients with and without penicillin allergy who underwent 9004 procedures at Massachusetts General Hospital from 2010 to 2014. All patients included in the study underwent hip arthroplasty, knee arthroplasty, hysterectomy, colon surgery, and/or coronary artery bypass grafting.

The primary outcome included SSI, based on the criteria set forth by the Centers for Disease Control and Prevention’s National Healthcare Safety Network. The secondary outcome included perioperative antibiotic use.

Results indicated that 922 (11%) patients had reported a penicillin allergy, and 241 (2.7%) had developed an SSI. Ultimately, as demonstrated by multivariable logistic regression, patients with a reported penicillin allergy had a higher risk of SSI, and this increased risk was entirely attributable to patients’ receipt of an alternative perioperative antibiotic. Those with a reported penicillin allergy received less cefazolin (12% vs 92%) and more clindamycin (49% vs 3%), vancomycin (35% vs 3%), and gentamicin (24% vs 3%) compared with those without a reported penicillin allergy.

The researchers noted that approximately 112 to 124 patients with a reported penicillin allergy would need an allergy evaluation in order to prevent 1 SSI.

“Patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of second-line perioperative antibiotics,” the researchers concluded. “Clarification of penicillin allergies as part of routine preoperative care may decrease SSI risk.”

—Christina Vogt

Reference:

Blumenthal KG, Ryan EE, 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. https://doi.org/10.1093/cid/cix794.