1012. The Safety of Cefazolin for Pre-operative Prophylaxis in Patients with Reported Beta-lactam Allergies
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • jain_poster_9-26-13.pdf (2.7 MB)
  • Background:  Cefazolin is the preferred pre-operative prophylactic agent for most orthopedic, upper GI, Cardiothoracic procedures at our institution.  Cefazolin is often avoided because of self-reported beta-lactam allergy, leading to the use of alternative prophylactic agents such as vancomycin, clindamycin or levofloxacin, which have greater cost, side effects and stewardship implications. Purpose:  To describe our experience using cefazolin in surgical prophylaxis despite reported beta-lactam allergy.

    Methods: Using a perioperative quality-assurance database, we reviewed the pre-operative prophylactic agents given to all patients prescribed antibiotics in 2011. 

    Results:  We found that 11.7% (1,723/14,773) of operations involving antibiotic prophylaxis were performed on patients who reported a beta-lactam allergy prior to surgery.  Patients received cefazolin (291, 16.9%), Vancomycin (373, 21.5%), Clindamycin (789, 45.5%), and/or other agents (279, 16.1%).  Of cases involving a history of beta-lactam allergy in which cefazolin was administered pre-operatively, no allergic reactions were documented in the OR (0/291).  Their prior allergic reactions were documented as anaphylaxis (5.8%), GI related (17.1%), rash (33%), hives (14.6%), itching (7.7%), unknown (1%), and/or unspecified (16.7%).   Among those cases involving patients without a history of beta-lactam allergy who received cefazolin, 9/10,327 (0.09%) had an allergic reaction to cefazolin in the OR.  Two of these patients had suspected anaphylaxis.

    Conclusion:  At our institution, cefazolin was safely administered in pre-operative prophylaxis despite a history of beta-lactam allergy.  This has implications for improved antimicrobial stewardship, including reduced vancomycin and clindamycin use in the OR.

    Rupali Jain, PharmD1, Meredith Holmes, PharmD2, Bala Nair, MD2,3, Drew Ayars, MD2, E. Patchen Dellinger, MD4, Gene Peterson, MD5 and Paul Pottinger, MD6, (1)Pharmacy, University of Washington Medical Center, Seattle, WA, (2)University of Washington, Seattle, WA, (3)Anesthia and Pain Medicine, University of Washington, Seattle, WA, (4)University of Washington Medical Center, Seattle, WA, (5)Department of Anesthesiology, University of Washington, Seattle, WA, (6)Division of Allergy and Infectious Disease, University of Washington, Seattle, WA

    Disclosures:

    R. Jain, None

    M. Holmes, None

    B. Nair, None

    D. Ayars, None

    E. P. Dellinger, None

    G. Peterson, None

    P. Pottinger, None

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