Jones Nick K, Tom Brian, Simillis Constantinos, Bennet John, Gourgiotis Stavros, Griffin Jo, Blaza Helen, Nasser Shuaib, Baker Stephen, Gouliouris Theodore
Department of Medicine, University of Cambridge, Cambridge, UK.
Cambridge Clinical Microbiology and Public Health Laboratory, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
JAC Antimicrob Resist. 2024 Feb 16;6(1):dlae022. doi: 10.1093/jacamr/dlae022. eCollection 2024 Feb.
Studies in the USA, Canada and France have reported higher surgical site infection (SSI) risk in patients with a penicillin allergy label (PAL). Here, we investigate the association between PALs and SSI in the UK, a country with distinct epidemiology of infecting pathogens and range of antimicrobial regimens in routine use.
Electronic health records and national SSI surveillance data were collated for a retrospective cohort of gastrointestinal surgery patients at Cambridge University Hospitals NHS Foundation Trust from 1 January 2015 to 31 December 2021. Univariable and multivariable logistic regression were used to examine the effects of PALs and the use of non-β-lactam-based prophylaxis on likelihood of SSI, 30 day post-operative mortality, 7 day post-operative acute kidney injury and 60 day post-operative infection/colonization with antimicrobial-resistant bacteria or .
Our data comprised 3644 patients and 4085 operations; 461 were undertaken in the presence of PALs (11.3%). SSI was detected after 435/4085 (10.7%) operations. Neither the presence of PALs, nor the use of non-β-lactam-based prophylaxis were found to be associated with SSI: adjusted OR (aOR) 0.90 (95% CI 0.65-1.25) and 1.20 (0.88-1.62), respectively. PALs were independently associated with increased odds of newly identified MRSA infection/colonization in the 60 days after surgery: aOR 2.71 (95% CI 1.13-6.49). Negative association was observed for newly identified infection/colonization with third-generation cephalosporin-resistant Gram-negative bacteria: aOR 0.38 (95% CI 0.16-0.89).
No evidence was found for an association between PALs and the likelihood of SSI in this large UK cohort, suggesting significant international variation in the impact of PALs on surgical patients.
美国、加拿大和法国的研究报告称，有青霉素过敏标签（PAL）的患者手术部位感染（SSI）风险更高。在此，我们调查在英国PAL与SSI之间的关联，英国感染病原体的流行病学和常规使用的抗菌方案范围都有所不同。
整理了剑桥大学医院国民保健服务基金会信托基金2015年1月1日至2021年12月31日期间胃肠道手术患者回顾性队列的电子健康记录和全国SSI监测数据。采用单变量和多变量逻辑回归来检验PAL以及使用非β-内酰胺类预防措施对SSI可能性、术后30天死亡率、术后7天急性肾损伤和术后60天抗菌药物耐药菌感染/定植的影响。
我们的数据包括3644例患者和4085例手术；461例手术是在有PAL的情况下进行的（11.3%）。4085例手术中有435例（10.7%）检测到SSI。未发现PAL的存在或使用非β-内酰胺类预防措施与SSI有关：调整后的比值比（aOR）分别为0.90（95%置信区间0.65 - 1.25）和1.20（0.88 - 1.62）。PAL与术后60天内新发现的耐甲氧西林金黄色葡萄球菌感染/定植几率增加独立相关：aOR为2.71（95%置信区间1.13 - 6.49）。对于新发现的对第三代头孢菌素耐药的革兰氏阴性菌感染/定植，观察到负相关：aOR为0.38（95%置信区间0.16 - 0.89）。
在这个大型英国队列中，未发现PAL与SSI可能性之间存在关联的证据，这表明PAL对外科患者的影响存在显著的国际差异。
