Wednesday, September 26, 2018 3:35 PM – 5:05 PM How to Avoid Complications: 97. Beta-lactam antibiotic surgical prophylaxis is safe in patients with self-reported penicillin allergies: a cohort study of lumbar spine surgery patients

Abstract

BACKGROUND CONTEXT The use of first-generation cephalosporin, cenfazolin, for antibiotic surgical prophylaxis in spine surgery remains strongly recommended. Given the distant cross-reactivity, patients with penicillin (PCN) allergies are often not administered cephalosporins, but instead given less optimal alternative antibiotics. The reliability, however, of patient-reported penicillin allergies has been disputed. PURPOSE The purpose of this study was to determine the safety of administering beta-lactam antibiotics in those reporting a PCN. STUDY DESIGN/SETTING Retrospective, single-institutional series. PATIENT SAMPLE All patients undergoing complex lumbar spinal surgery at the University of Iowa between 2015 and 2016 that were referred to the drug allergy clinic (DEA). OUTCOME MEASURES Comparison of penicillin skin testing results with patient reported drug allergies to PCN and/or beta-lactam antibiotics METHODS Twenty-nine patients undergoing lumbar spine surgery with reported PCN allergies were referred to a drug allergy clinic for evaluation of optimal surgical antibiotic prophylaxis. Of these referrals, 19 completed appointments in the allergy clinic where they underwent penicillin skin testing (PST), a drug challenge to a beta-lactam antibiotic, and/or had no intervention depending on the history obtained RESULTS Penicillin skin testing was performed on 17 of 19 (89%) patients. No testing was indicated in 2 patients as an allergy was ruled out by the history. A negative PST was noted in all 17 (100%) patients tested, indicating no penicillin allergy. Cefazolin was deemed safe to use in all 19 patients (100%) patients evaluated. Eighteen of the patients evaluated in the allergy clinic completed a lumbar surgery. Cefazolin in any surgical prophylaxis regimen was used in all 18 surgeries (100%) without any adverse perioperative reactions. CONCLUSIONS Patients with a self-reported history of PCN allergies are highly unlikely to have a reaction to beta-lactam antibiotics administered as surgical prophylaxis. A strong consideration should be given toward routine use of cefazolin despite reported allergies. Referral to a drug allergy clinic is an excellent option to optimize surgical antibiotic prophylaxis in those with self-reported allergies. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.