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The impact of a reported penicillin allergy on surgical site infection risk.
Open accessAbstract
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 (653,662–664).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [664]
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Citations
Cites
Clinical practice guidelines for antimicrobial prophylaxis in surgery
Bratzler, D. W., Dellinger, E. P., Olsen, K. M., Perl, T. M., Auwaerter, P. G., Bolon, M. K., Fish, D. N., Napolitano, L. M., Sawyer, R. G., Slain, D., et al. (2013) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp120568 · Cited by 2,600
Health Care–Associated Infections
Zimlichman, E., Henderson, D., Tamir, O., Franz, C., Song, P., Yamin, C. K., Keohane, C. A., Denham, C. R., & Bates, D. W. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.9763 · Cited by 1,927
Surveillance for asthma--United States, 1980-1999.
Mannino, D. M., Homa, D. M., Akinbami, L. J., Moorman, J. E., Gwynn, C., & Redd, S. C. (2002) · PubMed · Cited by 1,699
The Epidemiology of Wound Infection: A 10-Year Prospective Study of 62,939 Wounds
Cruse, P. J. E., & Foord, R. (1980) · Surgical Clinics of North America · doi:10.1016/s0039-6109(16)42031-1 · Cited by 1,394
Surgical site infection: Incidence and impact on hospital utilization and treatment costs
de Lissovoy, G., Fraeman, K. H., Hutchins, V., Murphy, D. M., Song, D. H., & Vaughn, B. B. (2009) · American Journal of Infection Control · doi:10.1016/j.ajic.2008.12.010 · Cited by 1,241
Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L. R., Nyquist, A., Saiman, L. M., Yokoe, D. S., Maragakis, L. L., et al. (2014) · Infection Control and Hospital Epidemiology · doi:10.1086/676022 · Cited by 1,216
Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery
Bratzler, D. W., Dellinger, E. P., Olsen, K. M., Perl, T. M., Auwaerter, P. G., Bolon, M. K., Fish, D. N., Napolitano, L. M., Sawyer, R. G., Slain, D., et al. (2013) · Surgical Infections · doi:10.1089/sur.2013.9999 · Cited by 1,200
Bratzler, D. W., & Houck, P. M. (2005) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2005.01.015 · Cited by 1,163
Drug Allergy: An Updated Practice Parameter
(2010) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2010.08.002 · Cited by 982
Dale, W., Peter, M. H., & Workgroup, F. T. S. I. P. G. W. (2004) · Clinical Infectious Diseases · doi:10.1086/421095 · Cited by 884
Research works printed but not linked: 1
- Centers for Disease Control and Prevention, 2017, Surgical Site Infection (SSI) Event
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 3,018
Evaluation and Management of Penicillin Allergy: A Review
Shenoy, E. S., Macy, E., Rowe, T., & Blumenthal, K. G. (2019) · JAMA · doi:10.1001/jama.2018.19283 · Cited by 830
Self-citationBlumenthal, K. G., Peter, J. G., Trubiano, J. A., & Phillips, E. J. (2019) · The Lancet · doi:10.1016/s0140-6736(18)32218-9 · Cited by 614
Self-citationDrug allergy: A 2022 practice parameter update
Khan, D. A., Banerji, A., Blumenthal, K. G., Phillips, E. J., Solensky, R., White, A. A., Bernstein, J. A., Chu, D. K., Ellis, A. K., Golden, D. B. K., et al. (2022) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2022.08.028 · Cited by 607
Self-citationStrategies to prevent surgical site infections in acute-care hospitals: 2022 Update
Calderwood, M. S., Anderson, D. J., Bratzler, D. W., Dellinger, E. P., Garcia‐Houchins, S., Maragakis, L. L., Nyquist, A., Perkins, K. M., Preas, M. A., Saiman, L. M., et al. (2023) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2023.67 · Cited by 328
Metadata
- 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
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-10-09
- Volume
- 66
- Issue
- 3
- Pages
- 329-336
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- 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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