Abstract：
BACKGROUND: Patients undergoing total joint arthroplasty (TJA) who report penicillin allergy (PA) are frequently administered second-line antibiotics, although recent evidence suggests that this may be unnecessary and could increase infection risk. Many institutions have aimed to improve antibiotic deployment via allergy testing and screening; however, there is little standardization to this process. This review aimed to evaluate (1) antibiotic selection in patients who report PA and assess the impact of screening and testing interventions, (2) rates of allergic reactions in patients who report PA, and (3) the association between reported PA and screening or testing programs and odds of surgical site infection or periprosthetic joint infection.
METHODS: PubMed, EBSCOhost, and Google Scholar electronic databases were searched on February 4, 2023 to identify all studies published since January 1, 2000 that evaluated the impact of PA on patients undergoing TJA (PROSPERO study protocol registration: CRD42023394031). Articles were included if full-text manuscripts in English were available, and the study analyzed the impact of PA and related interventions on TJA patients. There were 11 studies evaluating 1,276,663 patients included. Interventions were compared via presentation of key findings regarding rates of clinically relevant or high-risk PA reported upon screenings or testings, cephalosporin utilizations, allergic reactions, and postoperative infections (surgical site infection and periprosthetic joint infection).
RESULTS: All 6 studies found that PA screening and testing markedly increase the use of first-line antibiotics. Testing showed low rates of true allergy (0.7 to 3%) and allergic reaction frequency for patients who have reported PA receiving cephalosporins was between 0% and 2%. Although there were mixed findings across studies, there was a trend toward second-line antibiotic prophylaxis being associated with a slightly higher rate of infection in PA patients.
CONCLUSIONS: Using PA screening and testing can promote antibiotic stewardship by safely increasing the use of first-line antibiotics in patients who have a reported PA.
METHODS: Level III, Therapeutic Study.
METHODS: PubMed, EBSCOhost, and Google Scholar electronic databases were searched on February 4, 2023 to identify all studies published since January 1, 2000 that evaluated the impact of PA on patients undergoing TJA (PROSPERO study protocol registration: CRD42023394031). Articles were included if full-text manuscripts in English were available, and the study analyzed the impact of PA and related interventions on TJA patients. There were 11 studies evaluating 1,276,663 patients included. Interventions were compared via presentation of key findings regarding rates of clinically relevant or high-risk PA reported upon screenings or testings, cephalosporin utilizations, allergic reactions, and postoperative infections (surgical site infection and periprosthetic joint infection).
RESULTS: All 6 studies found that PA screening and testing markedly increase the use of first-line antibiotics. Testing showed low rates of true allergy (0.7 to 3%) and allergic reaction frequency for patients who have reported PA receiving cephalosporins was between 0% and 2%. Although there were mixed findings across studies, there was a trend toward second-line antibiotic prophylaxis being associated with a slightly higher rate of infection in PA patients.
CONCLUSIONS: Using PA screening and testing can promote antibiotic stewardship by safely increasing the use of first-line antibiotics in patients who have a reported PA.
METHODS: Level III, Therapeutic Study.
摘要：
背景：报告青霉素过敏（PA）的全关节置换术（TJA）患者经常服用二线抗生素，尽管最近的证据表明这可能是不必要的，并且可能增加感染风险。许多机构旨在通过过敏测试和筛查来改善抗生素的使用；然而，这个过程几乎没有标准化。这篇综述旨在评估：1）报告PA的患者的抗生素选择，并评估筛查和测试干预措施的影响；2）报告PA的患者的过敏反应率；3）报告的PA与筛查或测试计划之间的关联以及浅表皮肤感染（SSI）或假体周围关节感染（PJI）的几率。
方法：PubMed，EBSCOhost,和GoogleScholar电子数据库于2023年2月4日进行了搜索,以确定自2000年1月1日以来发表的所有研究,这些研究评估了PA对接受TJA的患者的影响(PROSPERO研究方案注册:CRD42023394031).如果有英文全文手稿，则包括文章，并分析PA及相关干预措施对TJA患者的影响。有11项研究评估了1,276,663名患者。通过筛选或测试时报告的临床相关或高风险PA发生率的关键发现来比较干预措施。头孢菌素的利用，过敏反应,和术后感染（SSI和PJI）。
结果：所有6项研究报告发现，PA筛查和检测显著增加了一线抗生素的使用。测试显示，真实过敏的发生率较低（0.7％至3％），并且报告PA接受头孢菌素的患者的过敏反应频率在0％至2％之间。虽然有不同的研究结果，在PA患者中,二线预防抗生素的趋势与感染率略高相关.
结论：使用PA筛查和检测可以通过安全地增加报告有PA的患者的一线抗生素的使用来促进抗生素管理。
方法：PubMed，EBSCOhost,和GoogleScholar电子数据库于2023年2月4日进行了搜索,以确定自2000年1月1日以来发表的所有研究,这些研究评估了PA对接受TJA的患者的影响(PROSPERO研究方案注册:CRD42023394031).如果有英文全文手稿，则包括文章，并分析PA及相关干预措施对TJA患者的影响。有11项研究评估了1,276,663名患者。通过筛选或测试时报告的临床相关或高风险PA发生率的关键发现来比较干预措施。头孢菌素的利用，过敏反应,和术后感染（SSI和PJI）。
结果：所有6项研究报告发现，PA筛查和检测显著增加了一线抗生素的使用。测试显示，真实过敏的发生率较低（0.7％至3％），并且报告PA接受头孢菌素的患者的过敏反应频率在0％至2％之间。虽然有不同的研究结果，在PA患者中,二线预防抗生素的趋势与感染率略高相关.
结论：使用PA筛查和检测可以通过安全地增加报告有PA的患者的一线抗生素的使用来促进抗生素管理。
