Abstract：
The study purpose was to assess adherence to a local surgical prophylaxis guideline in patients with reported penicillin allergies, which recommends cephalosporins as first-line prophylaxis.
Adult patients with penicillin allergies admitted for a surgical procedure from July 2020 to June 2021 were retrospectively screened, and the first surgery per admission was included. The primary outcome was the proportion of surgeries using β-lactam prophylaxis. Additional outcomes included prophylaxis timing, hypersensitivity reactions, acute kidney injury, infectious complications, duration of stay, and 30-day mortality or readmission.
Among 597 procedures, 504 patients (84.4%) received a β-lactam for surgical prophylaxis, including 494 (82.3%) who received a cephalosporin. Patients in the non-β-lactam group were more likely to have a type I IgE-mediated penicillin allergy (48.4% vs 31.7%, P = .002); however, the majority with type I reactions still received β-lactams (78.0%), including in the setting of anaphylaxis or angioedema to penicillin (67.7%). Zero allergic reactions to prophylaxis antibiotics were reported in either group, and there were no significant differences in the proportion of patients receiving drugs associated with the management of allergic reactions. Receipt of non-β-lactams was associated with inappropriate prophylaxis timing (9.7% vs 3.2%, P = .005) and postprocedural acute kidney injury (7.5% vs 0.6%, P < .001). All other outcomes were nonsignificant between the groups.
Among surgical patients with a documented penicillin allergy, most received cephalosporin prophylaxis as recommended by institutional guidelines, with zero allergic reactions. Receipt of non-β-lactam prophylaxis was associated with worsened outcomes. Cephalosporin prophylaxis should be preferred for surgical patients, including in the setting of true penicillin allergy.
Adult patients with penicillin allergies admitted for a surgical procedure from July 2020 to June 2021 were retrospectively screened, and the first surgery per admission was included. The primary outcome was the proportion of surgeries using β-lactam prophylaxis. Additional outcomes included prophylaxis timing, hypersensitivity reactions, acute kidney injury, infectious complications, duration of stay, and 30-day mortality or readmission.
Among 597 procedures, 504 patients (84.4%) received a β-lactam for surgical prophylaxis, including 494 (82.3%) who received a cephalosporin. Patients in the non-β-lactam group were more likely to have a type I IgE-mediated penicillin allergy (48.4% vs 31.7%, P = .002); however, the majority with type I reactions still received β-lactams (78.0%), including in the setting of anaphylaxis or angioedema to penicillin (67.7%). Zero allergic reactions to prophylaxis antibiotics were reported in either group, and there were no significant differences in the proportion of patients receiving drugs associated with the management of allergic reactions. Receipt of non-β-lactams was associated with inappropriate prophylaxis timing (9.7% vs 3.2%, P = .005) and postprocedural acute kidney injury (7.5% vs 0.6%, P < .001). All other outcomes were nonsignificant between the groups.
Among surgical patients with a documented penicillin allergy, most received cephalosporin prophylaxis as recommended by institutional guidelines, with zero allergic reactions. Receipt of non-β-lactam prophylaxis was associated with worsened outcomes. Cephalosporin prophylaxis should be preferred for surgical patients, including in the setting of true penicillin allergy.
摘要：
研究目的是评估报告有青霉素过敏的患者对当地手术预防指南的依从性。建议头孢菌素作为一线预防。
回顾性筛查了2020年7月至2021年6月接受外科手术的青霉素过敏成年患者。并包括每次入院的首次手术。主要结果是使用β-内酰胺预防的手术比例。其他结果包括预防时机，过敏反应,急性肾损伤，感染并发症,逗留时间,和30天死亡率或再入院。
在597个程序中，504名患者（84.4%）接受了β-内酰胺用于手术预防，包括494名（82.3%）接受头孢菌素治疗的患者。非β-内酰胺组的患者更可能患有I型IgE介导的青霉素过敏（48.4％vs31.7％，P=.002)；然而，大多数I型反应患者仍接受β-内酰胺(78.0%)，包括对青霉素的过敏反应或血管性水肿（67.7％）。两组均报告了对预防性抗生素的零过敏反应，接受与过敏反应管理相关的药物的患者比例没有显着差异。接受非β-内酰胺与不适当的预防时机相关（9.7％vs3.2％，P=0.005）和术后急性肾损伤（7.5%vs0.6%，P<.001)。所有其他结果在组间均无统计学意义。
在有青霉素过敏记录的手术患者中，大多数人接受了机构指南建议的头孢菌素预防，零过敏反应.接受非β-内酰胺预防与预后恶化相关。手术患者应首选头孢菌素预防，包括真正的青霉素过敏。
回顾性筛查了2020年7月至2021年6月接受外科手术的青霉素过敏成年患者。并包括每次入院的首次手术。主要结果是使用β-内酰胺预防的手术比例。其他结果包括预防时机，过敏反应,急性肾损伤，感染并发症,逗留时间,和30天死亡率或再入院。
在597个程序中，504名患者（84.4%）接受了β-内酰胺用于手术预防，包括494名（82.3%）接受头孢菌素治疗的患者。非β-内酰胺组的患者更可能患有I型IgE介导的青霉素过敏（48.4％vs31.7％，P=.002)；然而，大多数I型反应患者仍接受β-内酰胺(78.0%)，包括对青霉素的过敏反应或血管性水肿（67.7％）。两组均报告了对预防性抗生素的零过敏反应，接受与过敏反应管理相关的药物的患者比例没有显着差异。接受非β-内酰胺与不适当的预防时机相关（9.7％vs3.2％，P=0.005）和术后急性肾损伤（7.5%vs0.6%，P<.001)。所有其他结果在组间均无统计学意义。
在有青霉素过敏记录的手术患者中，大多数人接受了机构指南建议的头孢菌素预防，零过敏反应.接受非β-内酰胺预防与预后恶化相关。手术患者应首选头孢菌素预防，包括真正的青霉素过敏。
