Examining cefazolin utilization and perioperative anaphylaxis in patients with and without a penicillin allergy label: A cross-sectional study - 07/03/24

Doi : 10.1016/j.jclinane.2024.111377

Zachary R. Murphy, MD, MSE ^a,^{^{1
Shared first authorship}}, Anum F. Muzaffar, MD ^b,^{^{1
Shared first authorship}}, Sandra A. Massih, MS ^c, Eili Y. Klein, PhD ^d,^e, Melanie C. Dispenza, MD, PhD ^f, Valeria Fabre, MD ^g, Nadia B. Hensley, MD ^h, Kimberly G. Blumenthal, MD, MS ^i,^j,^k, Santiago Alvarez-Arango, MD ^c,^f,^l,^{^⁎}
^a Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States of America
^b Division of Allergy and Clinical Immunology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
^c Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
^d Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
^e Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
^f Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
^g Division of Infectious Disease, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
^h Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
ⁱ Harvard Medical School, Boston, MA, United States of America
^j Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
^k The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
^l Department of Pharmacology and Molecular Science, Johns Hopkins School of Medicine, Baltimore, MD, United States of America

^⁎Corresponding author at: Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.Division of Clinical Pharmacology, Department of MedicineJohns Hopkins School of MedicineBaltimoreMDUnited States of America

Abstract

Study objective

To compare the occurrence of cefazolin perioperative anaphylaxis (POA) in patients with and without a penicillin allergy label (PAL) to determine whether the prevalence of cefazolin POA differs based on the presence of a PAL.

Design

Cross-sectional study.

Setting

A large U.S. healthcare system in the Baltimore-D.C. region, July 2017 to July 2020.

Patients

112,817 surgical encounters across inpatient and outpatient settings in various specialties, involving 90,089 patients. Of these, 4876 (4.3%) encounters had a PAL.

Interventions

Perioperative cefazolin administration within 4 h before surgery to 4 h after the procedure began.

Measurements

The primary outcome was cefazolin POA in patients with and without PALs. Potential POA cases were identified based on tryptase orders or diphenhydramine administrations within the initial cefazolin administration to 6 h postoperatively. Verification included two validation steps. The first checked for hypersensitivity reaction (HSR) documentation, and the second, led by Allergy specialists, identified POA and the probable culprit. The secondary outcome looked at cefazolin use trends in patients with a PAL, stratified by setting and specialty.

Main results

Of 112,817 encounters, 1421 (1.3%) had possible cefazolin HSRs. Of these, 22 (1.5%) had POA, resulting in a 0.02% prevalence. Of these, 13 (59.1%) were linked to cefazolin and 9 (40.9%) attributed to other drugs. Only one cefazolin POA case had a PAL, indicating no significant difference in cefazolin POA prevalence between patients with and without PALs (p = 0.437). Perioperative cefazolin use in patients with PALs steadily increased from 2.6% to 6.0% between 2017 and 2020, specifically in academic settings.

Conclusions

The prevalence of cefazolin POA does not exhibit significant differences between patients with and without PALs, and notably, the incidence remains remarkably low. Based on these findings, it is advisable to view cefazolin as an acceptable choice for prophylaxis in patients carrying a PAL.

Il testo completo di questo articolo è disponibile in PDF.

Highlights

•	POA rate remains low at 0.02%, aligning with 1 in 1000 to 10,000 in prior reports.
•	Cefazolin POA rates are similar with/without PALs, echoing safety for PAL patients.
•	Rising cefazolin use in PAL patients signals a positive prescribing shift.
•	The complex POA study underlines the need for allergy-anesthesiology collaboration.
•	Promote guideline updates for cefazolin use in PAL patients.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Cefazolin surgical prophylaxis, Surgical-site infections, Penicillin allergy label, Drug allergy, Perioperative anaphylaxis, Cross-reactivity among beta-lactams

Abbreviations : AAAAI, ACAAI, EHR, ENT, HSR, ICD-10, IV, IM, IQR, JHHS, SSI, NLP, PAL, PMAP, POA

Mappa

Introduction

Materials and methods

CRediT authorship contribution statement

Esportazione

Vol 94

Articolo 111377- giugno 2024 Ritorno al numero

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