Outcomes From the Use of Cefazolin for Surgical Prophylaxis in Patients Allergic to Penicillin.

Abstract

Background: For surgical prophylaxis, alternatives to cefazolin are frequently used in patients with penicillin allergy due to the risk of cross-reactivity. This study investigated whether an evidence-based prescribing tool would result in an increased number of patients with a documented penicillin allergy receiving cefazolin for periprocedural antibiotic prophylaxis without an increase in allergic reactions.

Methods: This single-center, retrospective chart review analyzed patients with a documented penicillin allergy who received periprocedural antibiotics between February 1, 2023, and January 31, 2024. The primary objective was to determine the incidence of allergic reactions in patients with a documented penicillin allergy who received cefazolin perioperatively. Secondary outcomes included the appropriateness of antibiotic regimens in congruence with American System of Health Pharmacists (ASHP) recommendations, incidence of surgical site infections (SSIs), incidence of adverse drug reactions in those with a history of anaphylaxis vs nonanaphylaxis allergy, incidence of allergic reactions requiring interventions, and incidence of acute kidney injury (AKI).

Results: There were 197 surgical procedures in patients with a documented penicillin allergy. No allergic reactions were reported. In the cefazolin group, 126 antibiotic regimens (99.2%) were in congruence with ASHP recommendations; all regimens were in congruence with ASHP recommendations in the cefazolin plus gentamicin group; and 58 (86.6%) were in congruence with ASHP recommendations in the other antibiotic group. There was no incidence of SSI in the cefazolin or cefazolin plus gentamicin group, and 3 incidents in the other antibiotic group. One instance of AKI was reported in the cefazolin group, and none were reported in cefazolin plus gentamicin or the other antibiotic group.

Conclusions: This study reported similar outcomes to previously published research, which supports the perioperative use of cefazolin in patients allergic to penicillin, including those with a history of anaphylaxis.