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The impact of patient-reported penicillin or cephalosporin allergy on surgical site infections

Published online by Cambridge University Press:  09 June 2021

Jessica L. Seidelman Open the ORCID record for Jessica L. Seidelman [Opens in a new window] ,
Rebekah W. Moehring ,
David J. Weber ,
Deverick J. Anderson  and
Sarah S. Lewis
Jessica L. Seidelman*
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
David J. Weber
Affiliation:
Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
Deverick J. Anderson
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
Sarah S. Lewis
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
*
Author for correspondence: Jessica Seidelman, E-mail: [email protected]
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Abstract

Objective:

To determine the impact of a documented penicillin or cephalosporin allergy on the development of surgical site infections (SSIs).

Background:

Appropriate preoperative antibiotic prophylaxis reduces SSI risk, but documented antibiotic allergies influence the choice of prophylactic agents. Few studies have examined the relationship between a reported antibiotic allergy and risk of SSI and to what extent this relationship is modified by the antibiotic class given for prophylaxis.

Methods:

We conducted a retrospective cohort study of adult patients undergoing coronary artery bypass, craniotomy, spinal fusion, laminectomy, hip arthroplasty and knee arthroplasty at 3 hospitals from July 1, 2013, to December 31, 2017. We built a multivariable logistic regression model to calculate the adjusted odds ratio (aOR) of developing an SSI among patients with and without patient-reported penicillin or cephalosporin allergies. We also examined effect measure modification (EMM) to determine whether surgical prophylaxis affected the association between reported allergy and SSI.

Results:

We analyzed 39,972 procedures; 1,689 (4.2%) with a documented patient penicillin or cephalosporin allergy, and 374 (0.9%) resulted in an SSI. Patients with a reported penicillin or cephalosporin allergy were more likely to develop an SSI compared to patients who did not report an allergy to penicillin or cephalosporins (adjusted odds ratio, 3.26; 95% confidence interval, 2.71–3.93). Surgical prophylaxis did not have significant EMM on this association.

Conclusions:

Patients who reported a penicillin or cephalosporin allergy had higher odds of developing an SSI than nonallergic patients. However, the increase in odds is not completely mediated by the type of surgical prophylaxis. Instead, a reported allergy may be a surrogate marker for a more complicated patient population.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 7 , July 2022 , pp. 829 - 833
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. These data were presented at the 2019 Society for Healthcare Epidemiologists of America (SHEA) conference on April 25, 2019, in Boston, Massachusetts.

References

Lewis, SS, Moehring, RW, Chen, LF, Sexton, DJ, Anderson, DJ. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 2013;34:1229–1230.CrossRefGoogle Scholar
Zimlichman, E, Henderson, D, Tamir, O, et al. Healthcare–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle ScholarPubMed
Alexander, JW, Solomkin, JS, Edwards, MJ. Updated recommendations for control of surgical site infections. Ann Surg 2011;253:1082–1093.10.1097/SLA.0b013e31821175f8CrossRefGoogle ScholarPubMed
Bratzler, D, Dellinger, E, Olsen, K, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. AJHP 2013;70(3):195–283.Google Scholar
Epstein, RH, Jacques, PS, Wanderer, JP, Bombulie, MR, Agarwalla, N. Prophylactic antibiotic management of surgical patients noted as “allergic” to penicillin at two academic hospitals. Case Rept 2015;6:263–267.Google Scholar
Ponce, B, Raines, BT, Reed, RD, Vick, C, Richman, J, Hawn, M. Surgical site infection after arthroplasty: comparative effectiveness of prophylactic antibiotics—do surgical care improvement project guidelines need to be updated? J Bone Joint Surg 2014;96:970–977.10.2106/JBJS.M.00663CrossRefGoogle ScholarPubMed
Zhou, L, Dhopeshwarkar, N, Blumenthal, KG, et al. Drug allergies documented in electronic health records of a large healthcare system. Allergy 2016;71:1305–1313.CrossRefGoogle ScholarPubMed
Arroliga, ME, Radojicic, C, Gordon, SM, et al. A prospective observational study of the effect of penicillin skin testing on antibiotic use in the intensive care unit. Infect Control Hosp Epidemiol 2003;24:347–350.10.1086/502212CrossRefGoogle ScholarPubMed
Sagar, PS, Katelaris, CH. Utility of penicillin allergy testing in patients presenting with a history of penicillin allergy. Asia Pacific Allergy 2013;3:115–119.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
French, D, Noroozi, M, Shariati, B, Larjava, H. Clinical retrospective study of self-reported penicillin allergy on dental implant failures and infections. Quintessence Int 2016;47:861–870.Google ScholarPubMed
Pool, C, Kass, J, Spivack, J, et al. Increased surgical site infection rates following clindamycin use in head and neck free tissue transfer. Otolaryngology–Head Neck Surg 2016;154:272–278.CrossRefGoogle ScholarPubMed
Ristić, V, Maljanović, M, Harhaji, V, Milankov, M. Infections after reconstructions of anterior cruciate ligament. Medicinski pregled 2014;67:11–15.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network. Surgical Site Infection Event (SSI). Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Updated January 2018. Accessed December 23, 2020.Google Scholar
Duke Antimicrobial Stewardship Outreach Network (DASON). Duke University website. http://dason.medicine.duke.edu/home. Accessed January 7, 2021.Google Scholar
Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–1251.CrossRefGoogle ScholarPubMed
Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 suppl 2:S66–S88.CrossRefGoogle ScholarPubMed
Greenland, S, Pearl, J, Robins, JM. Causal diagrams for epidemiologic research. Epidemiology 1999;10:37–48.CrossRefGoogle ScholarPubMed
Blumenthal, KG, Oreskovic, NM, Fu, X, et al. High-cost, high-need patients: the impact of reported penicillin allergy. Am J Manag Care 2020;26:154–161.Google ScholarPubMed
Stone, AH, Kelmer, G, MacDonald, JH, Clance, MR, King, PJ. The impact of patient-reported penicillin allergy on risk for surgical site infection in total joint arthroplasty. J Am Acad Orthop Surg 2019;27:854–860.CrossRefGoogle ScholarPubMed
Tan, TL, Springer, BD, Ruder, JA, Ruffolo, MR, Chen, AF. Is vancomycin-only prophylaxis for patients with penicillin allergy associated with increased risk of infection after arthroplasty? Clin Orthop Relat Res 2016;474:1601–1606.CrossRefGoogle ScholarPubMed
Moskow, JM, Cook, N, Champion-Lippmann, C, Amofah, SA, Garcia, AS. Identifying opportunities in EHR to improve the quality of antibiotic allergy data. J Am Med Inform Assoc 2016;23(e1):e108–e112.CrossRefGoogle ScholarPubMed