Sarrazin Jean-François, Laaouaj Jamal, Philippon François, Sanchez Marina, Gervais Philippe, Champagne Jean, Steinberg Christian, Nault Isabelle, Roy Karine, Plourde Benoît, Blier Louis, O'Hara Gilles
Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec City, Canada.
Department of Infectious Disease, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec City, Canada.
CJC Open. 2022 Apr 28;4(8):695-700. doi: 10.1016/j.cjco.2022.04.007. eCollection 2022 Aug.
Cephalosporins are the cornerstone of cardiac device infection prophylaxis. Owing to fears of cross-reactivity, penicillin-allergic patients are exposed to potentially more-toxic drugs, with decreased efficacy. We evaluated the safety of a cefazolin test dose (CTD) in self-reported penicillin-allergic patients.
In this single-centre study, we evaluated consecutive patients with chart documentation of penicillin allergy undergoing cardiac device implantation, over a 2-year period. A CTD was performed if no cephalosporin allergy or severe anaphylactic reaction to penicillin had been documented. Patients were given 2 doses of 100 mg IV cefazolin, and if no allergic reaction occurred after 5 minutes, the full dose (1800 mg) was administered in the electrophysiology laboratory just before the implantation procedure.
A total of 2200 patients were included. The frequency of reported penicillin allergy was 9.3% (n = 204). In 80% of cases, the type of allergic reaction was not reported in medical notes or was unknown by the patient. A CTD was performed in 67.6% of patients with a penicillin allergy (n = 138). A total of 5 adverse events occurred (3.6% of patients [95% confidence interval, 1.1%-6.1%]) - 4 skin rashes and 1 tongue edema. These 5 patients became asymptomatic after antihistaminic and corticosteroid IV treatment. Even if the test dose was negative, 79% of patients also were administered vancomycin before the procedure, as it requires a 1-hour infusion prior to the CTD in the implantation procedure room.
A CTD in most penicillin-allergic patients appears to be safe and allows its use per recommended guidelines.
头孢菌素是预防心脏装置感染的基石。由于担心交叉反应，对青霉素过敏的患者会接触到潜在毒性更大的药物，且疗效降低。我们评估了头孢唑林试验剂量（CTD）在自述青霉素过敏患者中的安全性。
在这项单中心研究中，我们评估了连续2年有青霉素过敏病历记录且接受心脏装置植入的患者。如果没有头孢菌素过敏或对青霉素严重过敏反应的记录，则进行CTD。患者静脉注射2剂100mg头孢唑林，如果5分钟后没有过敏反应，则在植入手术前在电生理实验室给予全剂量（1800mg）。
共纳入2200例患者。自述青霉素过敏的频率为9.3%（n = 204）。在80%的病例中，病历中未报告过敏反应类型或患者不清楚。67.6%对青霉素过敏的患者（n = 138）进行了CTD。共发生5例不良事件（占患者的3.6%[95%置信区间，1.1%-6.1%]）——4例皮疹和1例舌水肿。这5例患者在静脉注射抗组胺药和皮质类固醇治疗后症状消失。即使试验剂量为阴性，79%的患者在手术前也接受了万古霉素治疗，因为在植入手术室进行CTD前需要1小时输注万古霉素。
大多数青霉素过敏患者的CTD似乎是安全的，可按照推荐指南使用。
