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

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

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

DOI 10.1093/cid/cix794PMC PMC5850334

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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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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
ORCID: Blumenthal, Kimberly G
Lee, Hang
Shenoy, Erica S
Venue: Clinical Infectious Diseases
Publisher: Oxford University Press (OUP)
Published: 2017-10-09
Volume: 66
Issue: 3
Pages: 329-336
ISSN: 1058-4838 (ISSN-L)
1537-6591
DOI: 10.1093/cid/cix794
PMC: PMC5850334
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: bronze
doi.org
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 (medical) › Drug-Induced Adverse Reactions
Health Sciences › Medicine › Infectious Diseases › 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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The impact of a reported penicillin allergy on surgical site infection risk.

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