Should Penicillin Allergy Testing Be Included as Part of Preoperative Testing?

Area of Science:

• Clinical immunology
• Infectious disease
• Surgical prophylaxis

Background:

• Penicillin allergy is frequently self-reported, leading to unnecessary broad-spectrum antibiotic use.
• Over-prescription of broad-spectrum antibiotics increases antibiotic resistance, morbidity, and healthcare costs.

Purpose of the Study:

• To determine the actual prevalence of penicillin allergy in surgical patients.
• To reduce the use of broad-spectrum antibiotics by identifying true penicillin allergies.

Main Methods:

• Retrospective chart review of urogynecologic surgery patients from 2017.
• Implementation of a quality initiative in 2018 offering preoperative penicillin allergy testing.

Main Results:

• In 2017, 15% of patients reported penicillin allergy, with 52% receiving broad-spectrum antibiotics.
• In 2018, 94% of patients who underwent penicillin allergy testing (and reported allergy) tested negative.
• 33 out of 35 patients (94%) who consented to testing were found not to have a penicillin allergy.

Conclusions:

• The vast majority of patients with a reported penicillin allergy do not have a true allergy.
• Preoperative penicillin allergy testing is a valuable tool for surgical patient management.
• Implementing allergy testing can decrease reliance on broad-spectrum antibiotics.