De-labeling of β-lactam allergy reduces intraoperative time and optimizes choice in antibiotic prophylaxis

Surgery
Yara MoussaChristos Tsoukas

Abstract

Suspected penicillin allergic individuals receive suboptimal non-β-lactams for intraoperative prophylaxis which may prolong operations and have negative clinical outcomes. We therefore studied if β-lactam de-labeling optimized choice of prophylactic antibiotics and improved intraoperative time efficiency. A multistep approach was used. It included a risk assessment tool by an allergist, β-lactam skin testing and oral provocation. To determine the value of de-labeling, we appraised intraoperative antibiotic choices and correlated them with time to first incision. A total of 194 patients were evaluated preoperatively. Four patients were diagnosed β-lactam allergic on skin testing. Of the remaining 190 skin test negative patients, 146 were β-lactam challenged. Only 5% reacted and were considered β-lactam allergic. Cefazolin became the perioperative antibiotic of choice for 77% of patients requiring antibiotic prophylaxis. Only 5 confirmed β-lactam allergic patients received intraoperative vancomycin. Patients avoiding use of vancomycin saved an average of 22 minutes in operative time. Of the 44 patients not having a β-lactam challenge, 36 received antibiotics and 18 (50%) of these were prescribed intraoperative cefazolin. Using th...Continue Reading

Citations

May 3, 2019·Allergy·Cosby A StoneElizabeth J Phillips
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May 25, 2020·The Journal of Allergy and Clinical Immunology·Bernardo Sousa-PintoJoão Almeida Fonseca
Jul 12, 2019·The Journal of Allergy and Clinical Immunology. in Practice·Yara MoussaChristos Tsoukas
Apr 27, 2021·British Journal of Clinical Pharmacology·Najah Ben FadhelKarim Aouam
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