SSI risk 50% higher in patients with recorded penicillin allergy

Surgical patients with a documented allergy to penicillin face a significantly higher risk of developing surgical site infections than patients with no recorded penicillin allergy, according to a study published in Clinical Infectious Diseases.

Researchers examined medical records of 8,400 patients who underwent common surgical procedures at Boston-based Massachusetts General Hospital from 2010 to 2014. Of the 8,400 patients, 922 had a penicillin allergy noted in their medical record.

The study shows 214 patients developed a SSI — 3.5 percent of patients with a documented penicillin allergy versus 2.6 percent of those without.

Researchers found, after adjusting for age, sex, race and the type and duration of surgery, patients with a documented penicillin allergy had a 50 percent higher risk of developing a SSI than patients who did not. Additionally, researchers found the only factor clearly associated with infection risk was the type of antibiotic patients received.

"We hope our findings spark reconsideration of the language about penicillin allergy testing in the national guidelines. In the meantime, I would recommend that any patients with a history of allergy to penicillin or to cephalosporins — the antibiotic class that includes cefazolin — who are scheduled for surgery to ask their doctor whether an antibiotic would be needed and, if so, discuss a referral for an allergy evaluation in advance to increase their chances of getting the most effective antibiotic," said senior author Erica Shenoy, MD, PhD, of MGH's division of infectious diseases and the infection control unit.

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