Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting

Sarfani, Shumaila; Stone, Cosby A.; Murphy, G. Andrew; Richardson, David R.

doi:10.5435/jaaos-d-21-00422

Cited by 8 publications

(11 citation statements)

References 36 publications

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“…The rate of patient-reported penicillin allergy ranges from 8 to 15% in the United States. However, only 5% of these patients have a true IgE-mediated allergy, including anaphylaxis, which is the most life-threatening immediate presentation of an allergic reaction, when tested [ 22 ]. Adverse effects of penicillin are considered to be associated with the formation of antibodies against metabolites of the penicillin molecule, specifically the R1 side chains of the β lactam ring [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the guidelines suggest taking into consideration the timing and pharmacokinetics (such as the serum half-life), as well as the necessary infusion time of the antibiotic [ 8 , 10 , 11 , 13 , 14 , 18 , 25 , 26 , 27 ]. Accordingly, if quinolones, aminoglycosides, or vancomycin are recommended, a timeframe of up to 2 h before surgical incision is allowable [ 8 , 10 , 11 , 14 , 22 , 25 ]. An overview regarding time of administration of antibiotic prophylaxis is presented in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Petousis,

Angelou,

Almperis

et al. 2024

JPM

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Surgical site infections (SSIs) refer to infections in the incision, organ, or postoperative space. As common healthcare-associated infections, SSIs correlate with prolonged hospital stay, additional procedures, ICU stay, and higher mortality rates. Around 8–10% of gynecologic surgery patients may experience infectious complications, influenced by microbial contamination, surgical nature, and patient factors. The goal of this narrative review is to compare and merge recommendations from globally published guidelines concerning the utilization of antibiotics in the perioperative phase. A comparative descriptive/narrative review of the guidelines issued by the American College of Obstetrics and Gynecology (ACOG), Society of Obstetricians and Gynecologists of Canada (SOGC), Royal College of Obstetricians and Gynecologists (RCOG), National Institute for Health and Care Excellence (NICE), Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG), European Society of Gynecologic Oncology (ESGO), Société Française d’ Anésthesie et de Réanimation (SFAR), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and Hellenic Society of Obstetrics and Gynecology (HSOG) was conducted. For hysterectomy, first/second-generation cephalosporins are suggested, with metronidazole as an option. Laparoscopy without entering the bowel or vagina typically does not require prophylaxis. Uterine evacuation and hysteroscopy may involve doxycycline or azithromycin based on risk factors, whereas, for vulvectomy, cefazolin is recommended. Urogynecology procedures may include cefazolin with metronidazole. In cases of penicillin allergy, cephalosporins are suggested, and, for obese patients, adjusted doses are advised. Additional doses may be needed for prolonged procedures or excessive blood loss. Timing recommendations are 15–60 min before incision, adjusting for specific antibiotics. Clear indications exist for certain surgeries like hysterectomy, termination of pregnancy, and urogynecologic procedures. Conversely, procedures such as intrauterine device insertion, hysteroscopy, and laparoscopy typically do not necessitate antibiotic prophylaxis. For several other procedures, the evidence is inconclusive, while considering dose, timing, and indications can mitigate infectious complications and provide benefits for the healthcare system.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Petousis,

Angelou,

Almperis

et al. 2024

JPM

View full text Add to dashboard Cite

show abstract

“…A history of allergies to antimicrobials will also guide prophylactic antibiotic choice [18] . However, the vast majority of patients who report a penicillin allergy do not have a true allergy and have been found to have a 50% increased odds of SSI due to the use of alternative surgical prophylaxis such as clindamycin or vancomycin.…”

Section: Surgical Prophylaxismentioning

confidence: 99%

Antibiotic use in spine surgery: A narrative review based in principles of antibiotic stewardship

Anwar,

Roca,

Khosla

et al. 2023

North American Spine Society Journal (NASSJ)

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“…Surgical site infection (SSI) is among the most lethal surgical complications both for surgeons and patients, leading to elevated postoperative morbidity and mortality rate (Beam and Osmon, 2018;Dagneaux et al, 2021;Sarfani et al, 2022). SSI is multifactorial, relating to patients' age, diabetic state, nutrition status, smoking history, etc.…”

Section: Introductionmentioning

confidence: 99%

The association between penicillin allergy and surgical site infection after orthopedic surgeries: a retrospective cohort study

Niu

Zhang

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundCephalosporins are used as first-line antimicrobial prophylaxis for orthopedics surgeries. However, alternative antibiotics are usually used in the presence of penicillin allergy (PA), which might increase the risk of surgical site infection (SSI). This study aimed to analyze the relationship between SSI after orthopedic surgeries and PA among surgical candidates and related alternative antibiotic use.MethodsIn this single-center retrospective cohort study, we compared inpatients with and without PA from January 2015 to December 2021. The primary outcome was SSI, and the secondary outcomes were SSI sites and perioperative antibiotic use. Moreover, pathogen characteristics of all SSIs were also compared between the two cohorts.ResultsAmong the 20,022 inpatient records, 1704 (8.51%) were identified with PA, and a total of 111 (0.55%) SSI incidents were reported. Compared to patients without PA, patients with PA had higher postoperative SSI risk (1.06%, 18/1704 vs. 0.51%, 93/18318), shown both in multivariable regression analysis (odds ratio [OR] 2.11; 95% confidence interval [CI], 1.26-3.50; p= 0.004) and propensity score matching (OR 1.84; 95% CI, 1.05-3.23; p= 0.034). PA was related to elevated deep SSI risk (OR 2.79; 95% CI, 1.47-5.30; p= 0.002) and had no significant impact on superficial SSI (OR 1.39; 95% CI, 0.59-3.29; p= 0.449). The PA group used significantly more alternative antibiotics. Complete mediation effect of alternative antibiotics on SSI among these patients was found in mediation analysis. Pathogen analysis revealed gram-positive cocci as the most common pathogen for SSI in our study cohort, while patients with PA had higher infection rate from gram-positive rods and gram-negative rods than non-PA group.ConclusionCompared to patients without PA, patients with PA developed more SSI after orthopedic surgeries, especially deep SSI. The elevated infection rate could be secondary to the use of alternative prophylactic antibiotics

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Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting

Cited by 8 publications

References 36 publications

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Antibiotic use in spine surgery: A narrative review based in principles of antibiotic stewardship

The association between penicillin allergy and surgical site infection after orthopedic surgeries: a retrospective cohort study

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