在加拿大一家主要教学医院中，对青霉素过敏的患者进行手术预防时，头孢唑林与其他抗生素相比的安全性。
Safety of administering cefazolin versus other antibiotics in penicillin-allergic patients for surgical prophylaxis at a major Canadian teaching hospital.
机构信息
ASPIRES (Antimicrobial Stewardship Programme), Medicine Quality and Safety, Vancouver Coastal Health, Vancouver, BC, Canada; Divisions of Medical Microbiology and Infection Control, and Infectious Diseases, Vancouver Coastal Health, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Division of Medical Microbiology, Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
出版信息
Surgery. 2021 Sep;170(3):783-789. doi: 10.1016/j.surg.2021.03.022. Epub 2021 Apr 21.
BACKGROUND
Cefazolin surgical prophylaxis is associated with better patient outcomes; however, its use in penicillin-allergic patients is controversial. We evaluated the safety of cefazolin as surgical prophylaxis in penicillin-allergic patients, including those with anaphylaxis histories.
METHODS
We conducted a pre and postintervention quality improvement evaluation of an institution-wide policy change at a tertiary-care hospital, before (October 2017-January 2018), during (February 2018-September 2018), and after (October 2018-October 2019) transition to routine cefazolin prophylaxis for penicillin-allergic patients, including those with anaphylaxis histories but excluding severe delayed reactions (eg, Stevens-Johnson syndrome). Retrospective data was collected on all surgical prophylaxis patients with penicillin-anaphylactic histories between October 2017 and September 2018. From October 2018, we prospectively reviewed adverse events with cefazolin. Primary outcome was adverse events in penicillin-allergic patients receiving cefazolin perioperatively.
RESULTS
From October 2017 to October 2019, 27,467 operations were performed. Of 220 patients with penicillin-anaphylactic histories reviewed prior to the full policy change, no statistically significant differences were reported in allergic reactions (P = .70), surgical site infections (P = 1.00), or adverse events (P = .32) with cefazolin compared to other antibiotics. Postpolicy implementation, cefazolin usage increased 18.2%, while vancomycin and clindamycin decreased by 11.4% and 62.0%, respectively. No anaphylaxis was documented in penicillin-allergic patients receiving cefazolin in either the review or quality assurance follow-up after the change. Of 3 patients developing reactions to cefazolin, none had histories of penicillin allergy. Surgical site infection rates were similar between pre and postpolicy time periods (P = .842).
CONCLUSION
Administration of cefazolin in penicillin-anaphylactic patients for surgical prophylaxis appears to be safe.
背景
头孢唑林用于外科预防可改善患者预后；然而，其在青霉素过敏患者中的应用仍存在争议。我们评估了头孢唑林作为青霉素过敏患者的外科预防用药的安全性，包括有过敏史的患者。
方法
我们在一家三级医院进行了一项机构范围政策变化的前后干预质量改进评估，在向常规头孢唑林预防用药（包括有过敏史但不包括严重迟发性反应（如史蒂文斯-约翰逊综合征）的患者）过渡之前（2017 年 10 月至 2018 年 1 月）、期间（2018 年 2 月至 2018 年 9 月）和之后（2018 年 10 月至 2019 年 10 月）。回顾性收集了 2017 年 10 月至 2018 年 9 月所有有青霉素过敏史的外科预防用药患者的数据。自 2018 年 10 月起，我们前瞻性地评估了头孢唑林的不良事件。主要结局是接受围手术期头孢唑林治疗的青霉素过敏患者的不良事件。
结果
在 2017 年 10 月至 2019 年 10 月期间，共进行了 27467 次手术。在全面政策变更前，对 220 例有青霉素过敏史的患者进行了回顾性分析，头孢唑林与其他抗生素相比，过敏反应（P=0.70）、手术部位感染（P=1.00）或不良事件（P=0.32）无统计学差异。实施政策后，头孢唑林的使用率增加了 18.2%，而万古霉素和克林霉素的使用率分别下降了 11.4%和 62.0%。在青霉素过敏患者中，无论是在政策变更后的回顾性分析还是质量保证随访中，均未记录到头孢唑林过敏。在使用头孢唑林的 3 例患者中，均无青霉素过敏史。术前和术后时间段的手术部位感染率相似（P=0.842）。
结论
头孢唑林用于青霉素过敏患者的外科预防似乎是安全的。
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