The use of perioperative cephalosporin prophylaxis in patients who have a pre-existing penicillin allergy.

Abstract

Studies have shown an association between a reported penicillin allergy and an increased risk of surgical site infection. The risk is due to avoidance of cephalosporins and to the use of alternative classes of antibiotics in surgical prophylaxis. The aim of this study was to examine the safety of using cephalosporins in patients with a penicillin allergy label. Patients with a primary or revision hip or knee arthroplasty in a tertiary care hospital between March 2020 and February 2023 were identified (n = 14,939). Information on prophylactic antibiotics, pre-existing antibiotic allergy labels before the operation, and all recorded new antibiotic allergy labels within 2 weeks after the operation was gathered. The prophylactic antibiotic use in patients with and without a penicillin allergy label was compared. In addition, all new antibiotic allergy labels recorded after the operation were verified from the electronic health records. A total of 1,435 (9.6%) patients had a previous penicillin allergy label. The majority of patients (14,838 of 14,939; 99.3%) received cephalosporin prophylaxis, as did most of the patients with a label of penicillin allergy (1,395 of 1,435; 97.2%). Six perioperative allergic reactions were recorded; none of these were anaphylactic reactions. In 5 cases, the allergic reaction occurred in patients receiving cefuroxime, none of whom had a previous penicillin allergy. This study found cephalosporin antibiotic prophylaxis to be safe in patients with a pre-existing penicillin allergy label.