SAFETY OF CEFAZOLIN PERIOPERATIVE PROPHYLAXIS IN PLASTIC SURGERY PATIENTS WITH PENICILLIN ALLERGY

Abstract

<h3>Introduction</h3> Preoperative antimicrobial prophylaxis, typically with first generation cephalosporin (cefazolin) is crucial in reducing surgical site infections (SSI) in plastic surgery patients. Despite low cross-reactivity with cefazolin, the presence of penicillin allergy (PA) on a patient's chart is known to result in the use of alternative antibiotics and increased risk of SSI in other surgical patients. Our study sought to examine patterns of perioperative antibiotics use and rates of reaction in plastic surgery patients with reported penicillin allergy in our institution, data yet to be investigated in this field. <h3>Methods</h3> This was a six-month, single-center retrospective chart review of adult patients of three body contouring plastic surgeons. Presence of PA, perioperative antibiotic administered, and patient outcomes including incidence of allergic reaction and SSI were recorded. <h3>Results</h3> 457 patients of which 91% (n=416) were female received 479 plastic surgery procedures. PA was listed in 16 (3.5%) patients documented as anaphylaxis, 57 (12.5%) non-anaphylactic hypersensitivity, and 7 (1.5%) unknown reaction. Cephalosporin allergy (CA) was reported in 18 (4%) of patients with 8 (1.7%) reporting both PA and CA. Of patients with PA, 30 (41%) received cefazolin and the rest received either clindamycin or ciprofloxacin. None developed anaphylaxis or a histamine-mediated reaction. 2 patients with PA who received clindamycin and 1 patient with PA who received cefazolin developed SSI. 1 patient with CA who received clindamycin developed SSI. <h3>Conclusion</h3> Cephalosporins remain first line perioperative prophylaxis for appropriate patients with PA. However, plastic surgeons still frequently choose alternative antibiotics, highlighting the need for further education.