256 Do Non-Beta-lactam antibiotics increase risk for surgical site infection after cesarean: a retrospective chart review

Abstract

A penicillin allergy is reported in up to 10% of obstetric patients. However, after allergy testing, only ∼1% of patients have a type 1 hypersensitivity reaction to penicillins. Traditionally, all patients who report an allergy to penicillins will receive treatment with a non-Beta-lactam antibiotic (gentamicin and clindamycin) instead of a Beta-lactam antibiotic (cefazolin) as antibiotic prophylaxis for cesarean sections. This is a standard, although there is only a 2% risk of cross-reactivity between penicillins and cephalosporins. It is known that multiple factors contribute to the risk of surgical site infection (SSI) including length of surgery, indication for surgery, type of incision, and medical comorbidities. However, in our institution, it is unknown if the type of antibiotic received affects the rate of infection. Providers suspect that a majority of patients readmitted with a wound infection received a non-Beta-lactam antibiotic for prophylaxis due to having a penicillin allergy. The hypothesis for this study is that patients with a penicillin allergy who receive non-Beta-lactam antibiotics for prophylaxis will have higher rates of SSI, compared to those without an allergy who receive a Beta-lactam antibiotic. This retrospective chart review included 1,163 patients who had a cesarean section between January 1, 2019 and January 31, 2020 at University Hospital in San Antonio. We compared SSI in patients who received non-Beta-lactam antibiotics to those who received Beta-lactam antibiotics. The incidence of SSI in patients who received non-Beta-lactams was 9.87% vs 4.71% (p-value 0.005) in those who received Beta-lactams. Patients treated with second-line therapy had greater than 2 times the risk of developing a post-operative infection. Given the finding that rates of infection were significantly greater in patients who received non-Beta-lactams, consideration should be given for pre-operative penicillin skin testing in patients with an allergy, which may lead to decreased surgical site infections, emergency room visits, and rates of readmission.View Large Image Figure ViewerDownload Hi-res image Download (PPT)