Journal article
Screening for Beta-Lactam Allergy in Joint Arthroplasty Patients to Improve Surgical Prophylaxis Practice
The Journal of arthroplasty, Vol.32(9), pp.S101-S108
09/2017
DOI: 10.1016/j.arth.2017.01.012
PMID: 28236547
Abstract
The reliability of patient-reported penicillin allergies has been disputed. A Drug Allergy Clinic (DAC) was established at our institution in combination with an electronic best practice alert (BPA) in the Orthopedic Clinic. Joint arthroplasty patients with a reported history of beta-lactam allergy (HOBA) were preoperatively referred via the BPA to the DAC. The purpose of this study was to determine the effectiveness of beta-lactam allergy screening in enabling the surgical team to optimize antimicrobial prophylaxis.
Between February 2013 and May 2015, 161 patients with a HOBA were referred to the DAC where they underwent penicillin skin testing (PST), a drug challenge to a beta-lactam antibiotic, and/or had no intervention depending on the history obtained.
PST was performed on 140 of 161 (87%) patients. A negative PST was noted in 139 (99%) patients, indicating no penicillin allergy. Cefazolin was safe to use in 145 (90%) patients evaluated. Significantly more patients evaluated in the DAC vs those not seen got cefazolin in any surgical prophylaxis regimen (90% vs 77%) without any adverse perioperative reactions. Concurrently, the use of non-beta-lactam antibiotics was significantly less in the patients evaluated vs not evaluated (16% vs 27%). The overall use of cefazolin in orthopedic surgeries in patients with HOBA was >84% over the course of the study period.
Beta-lactam allergy screening using a BPA and a DAC promotes the use of standard surgical prophylaxis with cefazolin. Joint arthroplasty surgeons should consider implementing allergy screening programs to promote antimicrobial stewardship.
Details
- Title: Subtitle
- Screening for Beta-Lactam Allergy in Joint Arthroplasty Patients to Improve Surgical Prophylaxis Practice
- Creators
- Deanna L McDanel - Department of Pharmaceutical Care, University of Iowa Healthcare, Iowa City, IowaAntoine E Azar - University of Iowa Carver College of Medicine, Iowa City, IowaAmy M Dowden - University of Iowa Carver College of Medicine, Iowa City, IowaSamantha Murray-Bainer - University of Iowa Carver College of Medicine, Iowa City, IowaNicolas O Noiseux - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IowaMelissa Willenborg - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IowaCharles R Clark - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IowaJohn J Callaghan - Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IowaAmbar Haleem - University of Iowa Carver College of Medicine, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of arthroplasty, Vol.32(9), pp.S101-S108
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.arth.2017.01.012
- PMID
- 28236547
- ISSN
- 0883-5403
- eISSN
- 1532-8406
- Language
- English
- Date published
- 09/2017
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Stead Family Department of Pediatrics; Orthopedics and Rehabilitation; Pharmacy Practice and Science; Immunology; Internal Medicine
- Record Identifier
- 9984040271102771
Metrics
18 Record Views