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Examining cefazolin utilization and perioperative anaphylaxis in patients with and without a penicillin allergy label: A cross-sectional study.
Murphy, Zachary R; Muzaffar, Anum F; Massih, Sandra A; Klein, Eili Y; Dispenza, Melanie C; Fabre, Valeria; Hensley, Nadia B; Blumenthal, Kimberly G; Alvarez-Arango, Santiago.
Afiliación
  • Murphy ZR; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States of America.
  • Muzaffar AF; Division of Allergy and Clinical Immunology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
  • Massih SA; Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
  • Klein EY; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America.
  • Dispenza MC; Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
  • Fabre V; Division of Infectious Disease, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
  • Hensley NB; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
  • Blumenthal KG; Harvard Medical School, Boston, MA, United States of America; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America; The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
  • Alvarez-Arango S; Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Department of Pharmaco
J Clin Anesth ; 94: 111377, 2024 06.
Article en En | MEDLINE | ID: mdl-38241788
ABSTRACT
STUDY

OBJECTIVE:

To compare the occurrence of cefazolin perioperative anaphylaxis (POA) in patients with and without a penicillin allergy label (PAL) to determine whether the prevalence of cefazolin POA differs based on the presence of a PAL.

DESIGN:

Cross-sectional study.

SETTING:

A large U.S. healthcare system in the Baltimore-D.C. region, July 2017 to July 2020. PATIENTS 112,817 surgical encounters across inpatient and outpatient settings in various specialties, involving 90,089 patients. Of these, 4876 (4.3%) encounters had a PAL.

INTERVENTIONS:

Perioperative cefazolin administration within 4 h before surgery to 4 h after the procedure began. MEASUREMENTS The primary outcome was cefazolin POA in patients with and without PALs. Potential POA cases were identified based on tryptase orders or diphenhydramine administrations within the initial cefazolin administration to 6 h postoperatively. Verification included two validation steps. The first checked for hypersensitivity reaction (HSR) documentation, and the second, led by Allergy specialists, identified POA and the probable culprit. The secondary outcome looked at cefazolin use trends in patients with a PAL, stratified by setting and specialty. MAIN

RESULTS:

Of 112,817 encounters, 1421 (1.3%) had possible cefazolin HSRs. Of these, 22 (1.5%) had POA, resulting in a 0.02% prevalence. Of these, 13 (59.1%) were linked to cefazolin and 9 (40.9%) attributed to other drugs. Only one cefazolin POA case had a PAL, indicating no significant difference in cefazolin POA prevalence between patients with and without PALs (p = 0.437). Perioperative cefazolin use in patients with PALs steadily increased from 2.6% to 6.0% between 2017 and 2020, specifically in academic settings.

CONCLUSIONS:

The prevalence of cefazolin POA does not exhibit significant differences between patients with and without PALs, and notably, the incidence remains remarkably low. Based on these findings, it is advisable to view cefazolin as an acceptable choice for prophylaxis in patients carrying a PAL.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hipersensibilidad a las Drogas / Anafilaxia Tipo de estudio: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Clin Anesth Asunto de la revista: ANESTESIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hipersensibilidad a las Drogas / Anafilaxia Tipo de estudio: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Clin Anesth Asunto de la revista: ANESTESIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos