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Cited by 69Surgical site infection preventionDrug-Induced Adverse ReactionsOrthopedic Infections and Treatments

Screening for beta-lactam allergy in joint arthroplasty patients to improve surgical prophylaxis practice.

McDanel, Deanna L., Azar, Antoine E., Dowden, Amy M., Murray-Bainer, Samantha, Noiseux, Nicolas O., Willenborg, Melissa, Clark, Charles R., Callaghan, John J. +1 more·2017·The Journal of Arthroplasty
DOI 10.1016/j.arth.2017.01.012
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Abstract

Background The reliability of patient-reported penicillin allergies has been disputed. A Drug Allergy Clinic (DAC) was established at our institution in combination with an electronic best practice alert (BPA) in the Orthopedic Clinic. Joint arthroplasty patients with a reported history of beta-lactam allergy (HOBA) were preoperatively referred via the BPA to the DAC. The purpose of this study was to determine the effectiveness of beta-lactam allergy screening in enabling the surgical team to optimize antimicrobial prophylaxis.Methods Between February 2013 and May 2015, 161 patients with a HOBA were referred to the DAC where they underwent penicillin skin testing (PST), a drug challenge to a beta-lactam antibiotic, and/or had no intervention depending on the history obtained.Results PST was performed on 140 of 161 (87%) patients. A negative PST was noted in 139 (99%) patients, indicating no penicillin allergy. Cefazolin was safe to use in 145 (90%) patients evaluated. Significantly more patients evaluated in the DAC vs those not seen got cefazolin in any surgical prophylaxis regimen (90% vs 77%) without any adverse perioperative reactions. Concurrently, the use of non-beta-lactam antibiotics was significantly less in the patients evaluated vs not evaluated (16% vs 27%). The overall use of cefazolin in orthopedic surgeries in patients with HOBA was >84% over the course of the study period.Conclusion Beta-lactam allergy screening using a BPA and a DAC promotes the use of standard surgical prophylaxis with cefazolin. Joint arthroplasty surgeons should consider implementing allergy screening programs to promote antimicrobial stewardship.

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  • Studies in preoperative surgical patients with reported penicillin allergy, evaluated for cardiovascular surgery or orthopedics, have rates of skin test positivity <8.5%.

    “Studies in preoperative surgical patients with reported penicillin allergy, evaluated for cardiovascular surgery (668) or orthopedics (669), have rates of skin test positivity <8.5%.”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [669]

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Authors
McDanel, D. L., Azar, A. E., Dowden, A. M., Murray-Bainer, S., Noiseux, N. O., Willenborg, M., Clark, C. R., Callaghan, J. J., & Haleem, A.
Affiliations
University of Iowa (US)
Corresponding author
Callaghan, John J.
ORCID
Venue
The Journal of Arthroplasty
Publisher
Elsevier BV
Published
2017-09
Volume
32
Issue
9
Pages
S101-S108
ISSN
0883-5403 (ISSN-L)
DOI
10.1016/j.arth.2017.01.012
OpenAlex
W2578433192
Cited by
69
References
15
Citations by year
2026: 3 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 9 · 2021: 9 · 2020: 12 · 2019: 7 · 2018: 7 · 2017: 2
FWCI
7.87
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Journal of Arthroplasty (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
  • Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
  • Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
Keywords
beta-lactam allergy, allergy screening, arthroplasty, cefazolin, penicillin skin testing, drug challenge, antibiotic prophylaxis, antimicrobial stewardship
MeSH terms
Adult, Aged, Aged, 80 and over, Anti-Infective Agents, Anti-Bacterial Agents, Arthroplasty, Cefazolin, Drug Hypersensitivity, Female, Humans, Male, Middle Aged, Penicillins, Retrospective Studies, Skin Tests, Reproducibility of Results, Antibiotic Prophylaxis, Arthroplasty, Replacement, beta-Lactams

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