Abstract
Objective To examine the relationship between documented β-lactam allergy and cesarean delivery (CD) surgical site infection (SSI). Study Design. We conducted a retrospective cohort analysis of women who underwent CD at Ben Taub Hospital and Texas Children's Pavilion for Women (Houston, TX) from August 1, 2011, to December 31, 2019. The primary exposure was a documented β-lactam allergy, and the second exposure of interest was the type of perioperative antibiotic received. The primary outcome was the prevalence of SSI. Maternal characteristics were stratified by the presence or absence of a documented β-lactam allergy, and significance was evaluated using Pearson's chi-squared test for categorical variables and t-test for continuous variables. A logistic regression model estimated odds of SSI after adjusting for possible confounders. Results Of the 12,954 women included, 929 (7.2%) had a documented β-lactam allergy while 12,025 (92.8%) did not. Among the 929 women with a β-lactam allergy, 495 (53.3%) received non-β-lactam perioperative prophylaxis. SSI occurred in 38 (4.1%) of women who had a β-lactam allergy versus 238 (2.0%) who did not (p ≤ 0.001). β-Lactam allergy was associated with higher odds of SSI compared to no allergy (adjusted odds ratio (aOR) = 1.97; 95%confidence interval (CI) = 1.24-3.14; p = 0.004) after controlling for age, race, ethnicity, insurance status, delivery body mass index (BMI), tobacco use, intra-amniotic infection in labor, duration of membrane rupture, preterm delivery, delivery indication, diabetes, hypertension, group B Streptococcus colonization, and type of perioperative antibiotic received. Conclusion The presence of a β-lactam allergy is associated with increased odds of developing a CD SSI after controlling for possible confounders, including the type of perioperative antibiotic received.
Highlights
Penicillin allergy is the most common drug allergy in the United States, with a 10-20% reported prevalence in hospitalized patients [1–6]
The purpose of this study is to examine the association between the presence of a documented β-lactam allergy and the prevalence of surgical site infection (SSI) following cesarean delivery (CD)
Indications for CD were significantly associated with documented β-lactam allergy (p = 0:046). (Table 1)
Summary
Penicillin allergy is the most common drug allergy in the United States, with a 10-20% reported prevalence in hospitalized patients [1–6]. Antimicrobial agents used for surgical prophylaxis ideally prevent SSI, prevent SSI-related morbidity and mortality, reduce the duration and cost of healthcare, produce no adverse effects, and have no adverse consequences on the microbial flora of the patient or hospital [8]. To achieve these goals, the agent should be active against the pathogens most likely to contaminate the surgical site, be administered at an adequate dosage and timed to ensure adequate serum and tissue concentrations during the time of contamination, be safe, and be Infectious Diseases in Obstetrics and Gynecology used for the shortest effective period to minimize adverse effects and the development of resistance [8]. These agents are typically less effective, leaving these patients at higher risk for SSI [3, 11]
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