Dong Ruizhi, Lanier Kasey, Kraft Casey, Skoracki Roman, Lehrman Craig, Kraft Monica
Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Division of Allergy and Immunology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Plast Surg (Oakv). 2025 Feb;33(1):159-163. doi: 10.1177/22925503231190929. Epub 2023 Aug 7.
Antimicrobial prophylaxis is crucial in reducing surgical site infections (SSIs). First-generation cephalosporins are commonly first line, but issues arise when patients report a penicillin allergy. Although up to 10% of Americans report a penicillin allergy, up to 95% are not truly allergic. Even patients with true penicillin allergy likely tolerate cephalosporins due to low cross-reactivity. Nevertheless, providers are less likely to prescribe cefazolin for these patients, increasing the risk of SSI. We seek to characterize the pattern of perioperative antibiotic use and rate of reaction in plastic surgery patients who endorse a penicillin allergy. This was a single-center retrospective chart review of adults who received body contouring plastic surgery from January 1, 2021 to December 31, 2021. The presence of reported penicillin allergy and administration of cefazolin versus alternative agent were evaluated, and the outcome was measured in number of anaphylactic reactions and SSI events. The study included 457 patients in total; 437 (96%) were female; 106 (23%) had listed allergy to penicillin, cephalosporin, or both - 17 (16%) were listed as having anaphylaxis to penicillin, 62 (58.5%) endorsed a nonanaphylactic allergic reaction to penicillin, 8 (7.5%) endorsed an allergy without a documented reaction to penicillin, and 19 (18%) reported a prior cephalosporin allergy. All patients with a beta-lactam allergy who received cefazolin perioperatively did not have any anaphylaxis events. Three patients who received clindamycin and 1 patient who received cefazolin developed SSI postoperatively. Cephalosporins should be the first line for appropriate patients with a penicillin allergy, as alternative agents have increased SSI risk.
抗菌预防对于减少手术部位感染（SSIs）至关重要。第一代头孢菌素通常是一线用药，但当患者报告对青霉素过敏时就会出现问题。尽管高达10%的美国人报告对青霉素过敏，但其中高达95%并非真正过敏。即使是真正对青霉素过敏的患者，由于交叉反应性低，也可能耐受头孢菌素。然而，医疗服务提供者给这些患者开头孢唑林的可能性较小，这增加了手术部位感染的风险。我们试图描述那些认可对青霉素过敏的整形外科患者围手术期抗生素使用模式和反应率。这是一项对2021年1月1日至2021年12月31日接受身体塑形整形手术的成年人进行的单中心回顾性病历审查。评估报告的青霉素过敏情况以及头孢唑林与替代药物的使用情况，并以过敏反应和手术部位感染事件的数量来衡量结果。该研究共纳入457名患者；437名（96%）为女性；106名（23%）列出对青霉素、头孢菌素或两者过敏——17名（16%）被列为对青霉素过敏，62名（58.5%）认可对青霉素有非过敏反应，8名（7.5%）认可对青霉素过敏但无记录反应，19名（18%）报告既往有头孢菌素过敏。所有围手术期接受头孢唑林的β-内酰胺类过敏患者均未发生任何过敏反应事件。3名接受克林霉素治疗的患者和1名接受头孢唑林治疗的患者术后发生了手术部位感染。对于对青霉素过敏的合适患者，头孢菌素应作为一线用药，因为替代药物会增加手术部位感染风险。
