False Penicillin Allergy - Risk for Surgical Site Infection

A surgical site infection is an infection that occurs after surgery on the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material resulting in longer hospital stay, more medical expense, and even death. Penicillin is Given to Prevent Surgical Site Infections (SSIs).
Perioperative antimicrobial prophylaxis is recommended for various surgical procedures to prevent surgical site infections. Prophylaxis refers to the prevention of an infection. Antibiotic selection is influenced by the organism most commonly causing wound infection in the specific procedure and by the relative costs of available agents. Penicillin is one such antibiotic commonly used antibiotic.

False Report of Penicillin Allergy - Increased Risk of Surgical Site Infections (SSIs)
When patients report allergy to penicillin, receipt of recommended antibiotic prophylaxis intended to prevent surgical site infections (SSIs) is compromised. Research at Massachusetts General Hospital (MGH) conducted a study over 8385 patients who underwent 9004 procedures and found that increased surgery site infection risk was entirely mediated by the patients’ receipt of an alternative perioperative antibiotic. Most patients with a reported penicillin allergy are not allergic but claimed that they are allergic to penicillin. This false report keeps patients at a fifty percent (50%) increased risk of surgery site infection.

The study reported that after adjustment for factors; such as age, sex, race and the type and duration of surgery, the risk of a surgical site infection was found to be 50 percent higher in patients with a reported penicillin allergy, and the only factor clearly associated with infection risk was the type of antibiotic patients received. A review of available information about the reactions leading to the patients’ allergy diagnoses revealed that practically all of them could have safely received standard testing for penicillin allergies. Only five had the kinds of severe hypersensitivity reactions that would rule out such testing.

Since current guidelines suggest that patients with a documented penicillin allergy not receive cefazolin, the standard antibiotic used to prevent surgical site infections, such patients often receive drugs such as clindamycin, vancomycin and gentamicin, which are known to be less effective against these infections, the authors note. Vancomycin additionally requires a longer infusion time than cefazolin, so the increased infection rate could also relate to the fact that practically all the presumed penicillin-allergic patients treated with vancomycin may have received it too close to surgical initiation for full effectiveness.

Shenoy says, "We hope our findings spark reconsideration of the language about penicillin allergy testing in the national guidelines. In the meantime, I would recommend that any patients with a history of allergy to penicillin or to cephalosporins - the antibiotic class that includes cefazolin - who are scheduled for surgery to ask their doctor whether an antibiotic would be needed and, if so, discuss a referral for an allergy evaluation in advance to increase their chances of getting the most effective antibiotic."

References:

1. Kimberly G. Blumenthal, Erin E. Ryan, Yu Li Hang Lee, James L. Kuhlen, Erica S. Shenoy. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk, Clinical Infectious Diseaseshttp://dx.doi.org/10.1093/cid/cix794

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Source-Eurekalert