Cited by 481Surgical site infection preventionDrug-Induced Adverse ReactionsAntibiotic Use and Resistance

The impact of a reported penicillin allergy on surgical site infection risk.

Open access
Blumenthal, Kimberly G, Ryan, Erin E, Li, Yu, Lee, Hang, Kuhlen, James L, Shenoy, Erica S·2018·Clinical Infectious Diseases

Abstract

Background: A reported penicillin allergy may compromise receipt of recommended antibiotic prophylaxis intended to prevent surgical site infections (SSIs). Most patients with a reported penicillin allergy are not allergic. We determined the impact of a reported penicillin allergy on the development of SSIs. Methods: In this retrospective cohort study of Massachusetts General Hospital hip arthroplasty, knee arthroplasty, hysterectomy, colon surgery, and coronary artery bypass grafting patients from 2010 to 2014, we compared patients with and without a reported penicillin allergy. The primary outcome was an SSI, as defined by the Centers for Disease Control and Prevention's National Healthcare Safety Network. The secondary outcome was perioperative antibiotic use. Results: Of 8385 patients who underwent 9004 procedures, 922 (11%) reported a penicillin allergy, and 241 (2.7%) had an SSI. In multivariable logistic regression, patients reporting a penicillin allergy had increased odds (adjusted odds ratio, 1.51; 95% confidence interval, 1.02-2.22) of SSI. Penicillin allergy reporters were administered less cefazolin (12% vs 92%; P < .001) and more clindamycin (49% vs 3%; P < .001), vancomycin (35% vs 3%; P < .001), and gentamicin (24% vs 3%; P < .001) compared with those without a reported penicillin allergy. The increased SSI risk was entirely mediated by the patients' receipt of an alternative perioperative antibiotic; between 112 and 124 patients with reported penicillin allergy would need allergy evaluation to prevent 1 SSI. Conclusions: Patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of second-line perioperative antibiotics. Clarification of penicillin allergies as part of routine preoperative care may decrease SSI risk.

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  • Multiple studies have described that persons with reported penicillin or another ß-lactam antibiotic allergy have higher rates of surgical-site infections, methicillin-resistant Staphylococcus aureus infections, and higher medical care usage.

    “Multiple studies have described that persons with reported penicillin or another ß-lactam antibiotic allergy have higher rates of surgical-site infections, methicillin-resistant Staphylococcus aureus infections, and higher medical care usage (653,662–664).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [664]

    The Conclusions report 50% higher odds of surgical-site infection in patients with a reported penicillin allergy, and the Abstract reports an association with MRSA colonization or infection. The paper does not establish higher medical-care usage in that group; the Cohort Characteristics section instead reports a slightly shorter hospital stay. Its study concerns reported penicillin allergy, not other β-lactam allergies generally. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK. Improving risk-ad- justed measures of surgical site infection for the national healthcare safety net- work. Infect Control Hosp Epidemiol 2011; 32:970-86.

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Authors
Blumenthal, K. G., Ryan, E. E., Li, Y., Lee, H., Kuhlen, J. L., & Shenoy, E. S.
Affiliations
  • Harvard University (US)
  • Massachusetts General Hospital (US)
  • University of South Carolina (US)
Corresponding author
Blumenthal, Kimberly G
Venue
Clinical Infectious Diseases
Published
2017-10-09
Volume
66
Issue
3
Pages
329-336
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
OpenAlex
W2761017407
Cited by
481
References
66
Citations by year
2026: 48 · 2025: 69 · 2024: 64 · 2023: 54 · 2022: 66 · 2021: 54 · 2020: 50 · 2019: 53 · 2018: 22 · 2017: 1
FWCI
35.31
Type
journal article
Language
en
Open access
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (UL1 TR001102, K01AI110524, K01AI125631)
  • National Center for Advancing Translational Sciences
  • American Academy of Allergy Asthma and Immunology
  • Massachusetts General Hospital
  • Massachusetts Institute of Technology
  • Harvard Catalyst
  • National Center for Research Resources
Topics
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
  • Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Keywords
penicillin allergy, surgical site infection, antibiotic prophylaxis, cefazolin, clindamycin, vancomycin, gentamicin, perioperative antibiotics, allergy evaluation, total hip arthroplasty, knee arthroplasty, hysterectomy, coronary artery bypass grafting, colon surgery
MeSH terms
Aged, Anti-Bacterial Agents, Clindamycin, Cross Infection, Drug Hypersensitivity, Female, Humans, Male, Massachusetts, Middle Aged, Penicillins, Retrospective Studies, Risk Factors, Surgical Wound Infection, Vancomycin, Odds Ratio, Antibiotic Prophylaxis, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee

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