Safety of administering cefazolin versus other antibiotics in penicillin-allergic patients for surgical prophylaxis at a major Canadian teaching hospital
Safety of administering cefazolin versus other antibiotics in penicillin-allergic patients for surgical prophylaxis at a major Canadian teaching hospital
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DOI：
10.1016/j.surg.2021.03.022
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发表时间：
2021-08-26
期刊：
影响因子：
3.8
通讯作者：
Lau, Tim T. Y.
中科院分区：
文献类型：
--
作者：
Grant, Jennifer M.;Song, Wendy H. C.;Lau, Tim T. Y.
背景资料：头孢唑林手术预防与更好的患者结局相关;然而，其在青霉素过敏患者中的使用存在争议。我们评估了头孢唑林作为青霉素过敏患者（包括有过敏史的患者）手术预防的安全性。研究方法：我们对一家三级保健医院的机构范围的政策变化进行了干预前后的质量改进评估，（2017年10月至2018年1月），期间（2018年2月至2018年9月），以及之后（2018年10月至2019年10月）青霉素过敏患者转为常规头孢唑林预防治疗，包括有过敏史的患者，但不包括严重的迟发反应（例如，史蒂文斯-约翰逊综合征）。收集了2017年10月至2018年9月期间所有有青霉素过敏史的手术预防性患者的回顾性数据。自2018年10月起，我们前瞻性审查了头孢唑林的不良事件。主要结局是青霉素过敏患者围手术期接受头孢唑啉的不良事件。结果：从2017年10月到2019年10月，共进行了27，467次手术。在全面政策变更前审查的220例有青霉素过敏史的患者中，头孢唑啉与其他抗生素相比，在过敏反应（P =.70）、手术部位感染（P = 1.00）或不良事件（P =.32）方面无统计学显著差异。政策实施后，头孢唑林的使用增加了18.2%，而万古霉素和克林霉素分别下降了11.4%和62.0%。在变更后的审查或质量保证随访中，接受头孢唑林的青霉素过敏患者未记录到过敏反应。在3例对头孢唑林发生反应的患者中，无青霉素过敏史。手术部位感染率在政策实施前后相似（P = 0.842）。结论：头孢唑林用于青霉素过敏患者的手术预防似乎是安全的。(c)2021爱思唯尔公司All rights reserved.
Background: Cefazolin surgical prophylaxis is associated with better patient outcomes; however, its use in penicillin-allergic patients is controversial. We evaluated the safety of cefazolin as surgical prophylaxis in penicillin-allergic patients, including those with anaphylaxis histories. Methods: We conducted a pre and postintervention quality improvement evaluation of an institution wide policy change at a tertiary-care hospital, before (October 2017-January 2018), during (February 2018-September 2018), and after (October 2018-October 2019) transition to routine cefazolin prophylaxis for penicillin-allergic patients, including those with anaphylaxis histories but excluding severe delayed reactions (eg, Stevens-Johnson syndrome). Retrospective data was collected on all surgical prophylaxis patients with penicillin-anaphylactic histories between October 2017 and September 2018. From October 2018, we prospectively reviewed adverse events with cefazolin. Primary outcome was adverse events in penicillin-allergic patients receiving cefazolin perioperatively. Results: From October 2017 to October 2019, 27,467 operations were performed. Of 220 patients with penicillin-anaphylactic histories reviewed prior to the full policy change, no statistically significant differences were reported in allergic reactions (P =.70), surgical site infections (P = 1.00), or adverse events (P =.32) with cefazolin compared to other antibiotics. Postpolicy implementation, cefazolin usage increased 18.2%, while vancomycin and clindamycin decreased by 11.4% and 62.0%, respectively. No anaphylaxis was documented in penicillin-allergic patients receiving cefazolin in either the review or quality assurance follow-up after the change. Of 3 patients developing reactions to cefazolin, none had histories of penicillin allergy. Surgical site infection rates were similar between pre and postpolicy time periods (P = .842). Conclusion: Administration of cefazolin in penicillin-anaphylactic patients for surgical prophylaxis appears to be safe. (c) 2021 Elsevier Inc. All rights reserved.