Home E-Weekly October 10, 2017

Penicillin Allergy Could Dramatically Increase SSI Risk

Published: October 9, 2017

TRULY ALLERGIC? Researchers say at least 95% of patients with a reported penicillin allergy can actually tolerate the drug.

Patients with a reported penicillin allergy are significantly more likely to develop post-op infections, according to research published in the journal Clinical Infectious Diseases.

Investigators looked at 8,385 patients who underwent surgeries, such as knee replacements or hysterectomies, at Massachusetts General Hospital between 2010 and 2014. Of those patients, 922 of them had a reported penicillin allergy. At the conclusion of the study, researchers found that a total of 214 patients had developed a surgical site infection — 3.5% were documented as having a penicillin allergy, compared with the 2.6% who were not. After adjusting those numbers for factors such as age and type of surgery, researchers noted that the risk for a surgical site infection jumped to 50% for those reported to have a penicillin allergy.

The researchers attribute their findings to the fact that patients who are reported to have a penicillin allergy aren't able to receive cefazolin, an antibiotic related to penicillin that is the leading medication used to prevent surgical site infections. Instead, those patients receive alternative drugs such as clindamycin or vancomycin, both of which are known to be less effective against surgical site infections.

"Cefazolin is easy to administer and gets into tissues in a relatively short period of time," study co-author Erica Shenoy, MD, PhD, an assistant physician in the department of infectious diseases at Massachusetts General. "Clindamycin has a higher risk of Clostridium difficile colitis, and thus vancomycin may be preferred."

But, she adds, vancomycin has its own pitfalls: It takes longer to infuse, which means patients may not get the full dose before procedures begin.

The researchers also point out that most patients with a reported penicillin allergy don't need to gamble with their post-operative health. "More than 95 percent of patients who believe they have a penicillin allergy can actually tolerate the drug," says lead researcher Kimberly Blumenthal, MD, a practicing allergist at Massachusetts General.

It's common for people to report penicillin allergies because of reactions they had as a child, but Dr. Blumenthal says that's all the more reason to get re-evaluated as an adult. "Often these reactions may not have been allergic reactions to begin with, but were drug-infection interactions," she says. "If there was a true allergic reaction as a child, the allergy might not still be present as an adult, because drug allergy wanes over time."

Dr. Shenoy hopes their findings "spark reconsideration of the language about penicillin allergy testing in the national guidelines." Until then, she recommends patients with a reported penicillin allergy get a physician referral for allergy evaluation before their scheduled surgeries in order to increase their chances of receiving the best antibiotic for preventing surgical site infections.

Brielle Gregory

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