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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: [email protected]
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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

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