Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Infect Control Hosp Epidemiol. 2020 Apr;41(4):438-443. doi: 10.1017/ice.2019.374. Epub 2020 Jan 23.
To assess whether a self-reported β-lactam allergy is associated with an increased risk of surgical site infection (SSI) across a broad range of procedures and to determine whether this association is mediated by the receipt of an alternate antibiotic to cefazolin.
Retrospective cohort study.
Surgical procedures sampled by an institutional National Surgical Quality Improvement Program database over an 18-month period (January 2017 to June 2018) from 7 surgical specialties.
Tertiary-care academic hospital.
Of the 3,589 surgical procedures included in the study, 369 (10.3%) were performed in patients with a reported β-lactam allergy. Those with a reported β-lactam allergy were significantly less likely to receive cefazolin (38.8% vs 95.5%) or metronidazole (20.3% vs 26.1%) and were more likely to receive clindamycin (52.0% vs 0.2%), gentamicin (3.5% vs 0%), or vancomycin (2.2% vs 0.1%) than those without allergy. An SSI occurred in 154 of 3,220 procedures (4.8%) in patients without reported allergy and 27 of 369 (7.3%) with reported allergy. In the multivariable regression model, a reported β-lactam allergy was associated with a statistically significant increase in SSI risk (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.04-2.51; P = .03). This effect was completely mediated by receipt of an alternate antibiotic to cefazolin (indirect effect aOR, 1.68; 95% CI, 1.17-2.34; P = .005).
Self-reported β-lactam allergy was associated with an increased SSI risk mediated through receipt of alternate antibiotic prophylaxis. Safely increasing use of cefazolin prophylaxis in patients with reported β-lactam allergy can potentially lower the risk of SSIs.
评估广泛手术范围内，自述β-内酰胺类过敏是否与手术部位感染（SSI）风险增加相关，并确定这种关联是否由头孢唑林替代抗生素的使用所介导。
回顾性队列研究。
18 个月期间（2017 年 1 月至 2018 年 6 月），从 7 个外科专业领域中，由一个机构性国家外科质量改进计划数据库抽样的外科手术。
三级保健学术医院。
研究纳入 3589 例外科手术，其中 369 例（10.3%）在报告有β-内酰胺类过敏的患者中进行。与无过敏报告的患者相比，有报告β-内酰胺类过敏的患者接受头孢唑林（38.8%比 95.5%）或甲硝唑（20.3%比 26.1%）的可能性显著降低，接受克林霉素（52.0%比 0.2%）、庆大霉素（3.5%比 0%）或万古霉素（2.2%比 0.1%）的可能性更高。在无过敏报告的 3220 例手术中，有 154 例（4.8%）发生 SSI，而在有过敏报告的 369 例手术中，有 27 例（7.3%）发生 SSI。在多变量回归模型中，报告的β-内酰胺类过敏与 SSI 风险的统计学显著增加相关（调整后比值比[aOR]，1.61；95%置信区间[CI]，1.04-2.51；P =.03）。这种效应完全通过头孢唑林替代抗生素的使用来介导（间接效应 aOR，1.68；95%CI，1.17-2.34；P =.005）。
自述β-内酰胺类过敏与通过使用替代抗生素预防而导致的 SSI 风险增加相关。安全增加有报告β-内酰胺类过敏患者的头孢唑林预防用药，可能降低 SSI 风险。
