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Published on: August 30, 2018
Optimizing preoperative prophylaxis in patients with reported β-lactam allergy: a novel extension of antimicrobial
Alon Vaisman1, Janine McCready2, Sandy Hicks3
1Division of Infectious Diseases, University Health Network, Toronto, Ontario M5G 2C4, Canada.
Background:
Use of alternative second-line antibiotics is associated with adverse events in patients reporting β-lactam allergy. In the perioperative setting, we hypothesized that structured allergy histories, without the use of skin testing, can reduce alternative prophylactic antibiotic use.
Objectives:
Assess the impact of structured allergy histories on patients with self-reported β-lactam allergy (SRBA) undergoing elective surgical procedures.
Methods:
Structured allergy histories were performed by a pharmacist and reviewed with an infectious diseases physician. Patients were deemed safe to proceed with cefazolin prophylaxis if they did not describe a history of type I-mediated or severe reaction. Antibiotic prophylaxis orders (with approval by the surgical team) were scheduled into the computerized order entry system to be given prior to first incision of the operation.
Results:
Of the 485 patients with SRBA that underwent structured allergy histories, 117 (24.1%) reported a type I-mediated allergy history; 267 (55.1%) patients received cefazolin prophylaxis and none subsequently experienced an adverse reaction. After intervention implementation, the overall use of alternative antibiotic prophylaxis at Michael Garron Hospital (Toronto, Canada) among those with SRBA decreased from 81.9% to 55.9%. This drop was associated with the number of monthly assessments (P < 0.001) in a regression analysis.
Conclusions:
Using a simple structured history and the principles of prospective audit and feedback, we were able to increase the use of cefazolin perioperative prophylaxis without any serious adverse events and in the absence of skin testing or diagnostic challenges.
Insights
Structured allergy histories can safely reduce alternative antibiotic use in patients with beta-lactam allergy undergoing surgery. This approach increased cefazolin use without adverse events, improving perioperative antibiotic prophylaxis.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Surgical Prophylaxis
Background:
- Alternative second-line antibiotics in beta-lactam allergic patients are linked to adverse events.
- Structured allergy histories, without skin testing, may decrease alternative prophylactic antibiotic use in surgery.
Purpose of the Study:
- To evaluate the effect of structured allergy histories on patients with self-reported beta-lactam allergy (SRBA) undergoing elective surgery.
Main Methods:
- Pharmacists conducted structured allergy histories, reviewed by infectious diseases physicians.
- Patients with no history of type I-mediated or severe reactions were cleared for cefazolin prophylaxis.
- Antibiotic prophylaxis orders were integrated into the computerized system for pre-incision administration.
Main Results:
- 267 out of 485 patients (55.1%) with SRBA received cefazolin prophylaxis without adverse events.
- Perioperative alternative antibiotic prophylaxis use decreased from 81.9% to 55.9% post-intervention.
- The reduction in alternative antibiotic use correlated with monthly assessment frequency (P < 0.001).
Conclusions:
- Structured allergy histories and prospective audit/feedback can increase cefazolin use for perioperative prophylaxis.
- This strategy achieved increased cefazolin use without necessitating skin testing or diagnostic challenges.
- No serious adverse events were observed, demonstrating the safety of this approach.
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