McDanel Deanna L, Azar Antoine E, Dowden Amy M, Murray-Bainer Samantha, Noiseux Nicolas O, Willenborg Melissa, Clark Charles R, Callaghan John J, Haleem Ambar
Department of Pharmaceutical Care, University of Iowa Healthcare, Iowa City, Iowa; University of Iowa College of Pharmacy, Iowa City, Iowa.
University of Iowa Carver College of Medicine, Iowa City, Iowa; University of Iowa Healthcare, Iowa City, Iowa; Johns Hopkins University, Baltimore, Maryland.
J Arthroplasty. 2017 Sep;32(9S):S101-S108. doi: 10.1016/j.arth.2017.01.012. Epub 2017 Jan 17.
The reliability of patient-reported penicillin allergies has been disputed. A Drug Allergy Clinic (DAC) was established at our institution in combination with an electronic best practice alert (BPA) in the Orthopedic Clinic. Joint arthroplasty patients with a reported history of beta-lactam allergy (HOBA) were preoperatively referred via the BPA to the DAC. The purpose of this study was to determine the effectiveness of beta-lactam allergy screening in enabling the surgical team to optimize antimicrobial prophylaxis.
Between February 2013 and May 2015, 161 patients with a HOBA were referred to the DAC 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.
PST was performed on 140 of 161 (87%) patients. A negative PST was noted in 139 (99%) patients, indicating no penicillin allergy. Cefazolin was safe to use in 145 (90%) patients evaluated. Significantly more patients evaluated in the DAC vs those not seen got cefazolin in any surgical prophylaxis regimen (90% vs 77%) without any adverse perioperative reactions. Concurrently, the use of non-beta-lactam antibiotics was significantly less in the patients evaluated vs not evaluated (16% vs 27%). The overall use of cefazolin in orthopedic surgeries in patients with HOBA was >84% over the course of the study period.
Beta-lactam allergy screening using a BPA and a DAC promotes the use of standard surgical prophylaxis with cefazolin. Joint arthroplasty surgeons should consider implementing allergy screening programs to promote antimicrobial stewardship.
患者自述的青霉素过敏的可靠性一直存在争议。我们机构设立了药物过敏诊所（DAC），并在骨科诊所结合使用电子最佳实践警报（BPA）。有β-内酰胺过敏史（HOBA）的关节置换患者术前通过BPA被转诊至DAC。本研究的目的是确定β-内酰胺过敏筛查在使手术团队优化抗菌预防方面的有效性。
在2013年2月至2015年5月期间，161例有HOBA的患者被转诊至DAC，在那里他们接受了青霉素皮肤试验（PST）、β-内酰胺抗生素药物激发试验，和/或根据所获病史未接受任何干预。
161例患者中的140例（87%）接受了PST。139例（99%）患者PST结果为阴性，表明无青霉素过敏。在接受评估的145例（90%）患者中，头孢唑林使用安全。与未就诊的患者相比，在DAC接受评估的患者在任何手术预防方案中使用头孢唑林的比例显著更高（90%对77%），且无任何围手术期不良反应。同时，接受评估的患者与未接受评估的患者相比，非β-内酰胺抗生素的使用显著减少（16%对27%）。在研究期间，HOBA患者在骨科手术中头孢唑林的总体使用率>84%。
使用BPA和DAC进行β-内酰胺过敏筛查可促进头孢唑林在标准手术预防中的使用。关节置换外科医生应考虑实施过敏筛查计划以促进抗菌管理。
