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Safety of Cefazolin Perioperative Prophylaxis in Plastic Surgery Patients With Penicillin Allergy: A Retrospective
Ruizhi Dong1, Kasey Lanier2,3, Casey Kraft4
1Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Insights
Patients with penicillin allergies can safely receive cefazolin, a first-generation cephalosporin, to prevent surgical site infections (SSIs). Alternative antibiotics increase SSI risk, while cefazolin shows low cross-reactivity and no anaphylaxis in this study.
Area of Science:
- Infectious Disease
- Allergy and Immunology
- Plastic Surgery
Background:
- Antimicrobial prophylaxis is essential for preventing surgical site infections (SSIs).
- First-generation cephalosporins are standard prophylaxis, but their use is limited in patients reporting penicillin allergy.
- A high percentage of reported penicillin allergies are inaccurate, and true allergy often has low cross-reactivity with cephalosporins.
Purpose of the Study:
- To analyze perioperative antibiotic prescribing patterns in plastic surgery patients with reported penicillin allergies.
- To assess the rate of allergic reactions and SSIs in these patients based on antibiotic choice.
- To evaluate the safety and efficacy of cefazolin in patients with a history of penicillin allergy.
Main Methods:
- Retrospective chart review of adult patients undergoing body contouring plastic surgery (2021-2021).
- Evaluation of reported penicillin allergy status and perioperative antibiotic administration (cefazolin vs. alternatives).
- Outcomes measured included anaphylactic reactions and surgical site infection (SSI) events.
Main Results:
- Of 457 patients, 106 (23%) reported a penicillin or cephalosporin allergy.
- No anaphylaxis events occurred in patients with beta-lactam allergies who received cefazolin.
- Four SSIs occurred: three with clindamycin and one with cefazolin.
Conclusions:
- Cefazolin is a safe and appropriate first-line antimicrobial prophylaxis for patients with a penicillin allergy.
- Prescribing cefazolin in appropriate patients with penicillin allergy does not increase the risk of anaphylaxis.
- Alternative antibiotic agents are associated with a higher risk of surgical site infections compared to cefazolin.
Abstract:
Introduction: Antimicrobial prophylaxis is crucial in reducing surgical site infections (SSIs). First-generation cephalosporins are commonly first line, but issues arise when patients report a penicillin allergy. Although up to 10% of Americans report a penicillin allergy, up to 95% are not truly allergic. Even patients with true penicillin allergy likely tolerate cephalosporins due to low cross-reactivity. Nevertheless, providers are less likely to prescribe cefazolin for these patients, increasing the risk of SSI. We seek to characterize the pattern of perioperative antibiotic use and rate of reaction in plastic surgery patients who endorse a penicillin allergy. Method: This was a single-center retrospective chart review of adults who received body contouring plastic surgery from January 1, 2021 to December 31, 2021. The presence of reported penicillin allergy and administration of cefazolin versus alternative agent were evaluated, and the outcome was measured in number of anaphylactic reactions and SSI events. Results: The study included 457 patients in total; 437 (96%) were female; 106 (23%) had listed allergy to penicillin, cephalosporin, or both - 17 (16%) were listed as having anaphylaxis to penicillin, 62 (58.5%) endorsed a nonanaphylactic allergic reaction to penicillin, 8 (7.5%) endorsed an allergy without a documented reaction to penicillin, and 19 (18%) reported a prior cephalosporin allergy. All patients with a beta-lactam allergy who received cefazolin perioperatively did not have any anaphylaxis events. Three patients who received clindamycin and 1 patient who received cefazolin developed SSI postoperatively. Conclusion: Cephalosporins should be the first line for appropriate patients with a penicillin allergy, as alternative agents have increased SSI risk.
