Documented β-Lactam Allergy and Risk for Cesarean Surgical Site Infection

Abstract

Objective. To examine the relationship between documented β-lactam allergy and cesarean delivery (CD) surgical site infection (SSI). Study Design. We conducted a retrospective cohort analysis of women who underwent CD at Ben Taub Hospital and Texas Children’s Pavilion for Women (Houston, TX) from August 1, 2011, to December 31, 2019. The primary exposure was a documented β-lactam allergy, and the second exposure of interest was the type of perioperative antibiotic received. The primary outcome was the prevalence of SSI. Maternal characteristics were stratified by the presence or absence of a documented β-lactam allergy, and significance was evaluated using Pearson’s chi-squared test for categorical variables and t -test for continuous variables. A logistic regression model estimated odds of SSI after adjusting for possible confounders. Results. Of the 12,954 women included, 929 (7.2%) had a documented β-lactam allergy while 12,025 (92.8%) did not. Among the 929 women with a β-lactam allergy, 495 (53.3%) received non-β-lactam perioperative prophylaxis. SSI occurred in 38 (4.1%) of women who had a β-lactam allergy versus 238 (2.0%) who did not ( p ≤ 0.001 ). β-Lactam allergy was associated with higher odds of SSI compared to no allergy ( adjusted odds ratio aOR = 1.97 ; 95 % confidence interval CI = 1.24 -3.14; p = 0.004 ) after controlling for age, race, ethnicity, insurance status, delivery body mass index (BMI), tobacco use, intra-amniotic infection in labor, duration of membrane rupture, preterm delivery, delivery indication, diabetes, hypertension, group B Streptococcus colonization, and type of perioperative antibiotic received. Conclusion. The presence of a β-lactam allergy is associated with increased odds of developing a CD SSI after controlling for possible confounders, including the type of perioperative antibiotic received.

Evaluating the cost-effectiveness of testing pregnant women for penicillin allergy

“…For this reason, ACOG has recommended penicillin allergy testing for pregnant women who report a penicillin or amoxicillin allergy [13]. This recommendation aligns with the American Academy of Allergy, Asthma and Immunology's 2016 recommendation that penicillin allergy testing should be routinely performed on all patients with a listed allergy to penicillin, ampicillin, or amoxicillin [14]. Using economic modeling, Sousa-Pinto et al evaluated penicillin allergy testing techniques to evaluate cost-savings in 24 decision models [15].…”

Effectiveness of chlorhexidine versus povidone‐iodine for preventing surgical site wound infection: A meta‐analysis

“…[3][4][5] Therefore, preventing and minimising the occurrence of SSI can improve patient outcomes and significantly reduce healthcare resource consumption. 6 Strategies to reduce the risk of SSI include preoperative, intraoperative and postoperative interventions. Preoperative skin disinfection is an important measure in preventing SSI, with chlorhexidine and povidone-iodine being the most commonly used skin disinfectants.…”

“…Additionally, it places a significant economic burden on the healthcare system 3–5 . Therefore, preventing and minimising the occurrence of SSI can improve patient outcomes and significantly reduce healthcare resource consumption 6 …”

“… 3 , 4 , 5 Therefore, preventing and minimising the occurrence of SSI can improve patient outcomes and significantly reduce healthcare resource consumption. 6 …”