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Utility of beta-lactam allergy assessment in patients receiving vancomycin for surgical prophylaxis
Kendall J Tucker1, YoungYoon Ham2, Haley K Holmer3
1Department of Pharmacy Practice, College of Pharmacy, Oregon State University, United States.
Background:
Beta-lactam antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between penicillins and cephalosporins, patients with beta-lactam allergies commonly receive vancomycin as an alternative to avoid allergic reaction.
Methods:
Adult patients receiving vancomycin for surgical prophylaxis with a reported beta-lactam allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis.
Results:
Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported beta-lactam allergy and were included in the analysis. Approximately 40 % of surgeries were orthopedic. Of patients receiving vancomycin as first-line therapy, 189 (96.4 %) were potentially eligible for beta-lactam prophylaxis.
Conclusions:
Patients with beta-lactam allergies often qualify for receipt of a first-line antibiotic. An opportunity exists for improved allergy assessment as an antimicrobial stewardship intervention in surgical prophylaxis.
Insights
Patients with beta-lactam allergies often receive vancomycin for surgical prophylaxis, but many are eligible for first-line beta-lactam antibiotics. Improved allergy assessment can optimize antimicrobial stewardship.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Surgical Prophylaxis
Background:
- Beta-lactam antibiotics are standard for surgical prophylaxis.
- Patients with reported beta-lactam allergies often receive vancomycin, despite low cross-reactivity with penicillins and cephalosporins.
- This practice aims to prevent allergic reactions.
Purpose of the Study:
- To evaluate adult patients receiving vancomycin for surgical prophylaxis due to reported beta-lactam allergy.
- To determine their eligibility for penicillin allergy testing or standard beta-lactam prophylaxis.
- To identify opportunities for antimicrobial stewardship interventions.
Main Methods:
- Retrospective evaluation of adult patients from August 2017 to July 2018.
- Inclusion criteria: vancomycin for surgical prophylaxis with a reported beta-lactam allergy.
- Analysis of eligibility for beta-lactam prophylaxis or allergy testing.
Main Results:
- 830 patients received vancomycin; 196 reported beta-lactam allergy.
- Orthopedic surgeries accounted for approximately 40% of cases.
- 189 (96.4%) of patients receiving vancomycin as first-line therapy were eligible for beta-lactam prophylaxis.
Conclusions:
- Many patients with beta-lactam allergies are suitable candidates for first-line antibiotic prophylaxis.
- Enhanced allergy assessment is crucial for effective antimicrobial stewardship in surgical settings.
- Optimizing antibiotic selection can improve patient care and reduce unnecessary vancomycin use.
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