Original ArticleReduction of Vancomycin Use in Orthopedic Patients With a History of Antibiotic Allergy
Section snippets
Study Patients
The study participants were patients with a history of antibiotic allergy who were scheduled for orthopedic surgery. Patients with a history of cephalosporin allergy or other antibiotic allergy were included if they were referred for evaluation of antibiotic prophylaxis. All patients were scheduled for an orthopedic procedure, most for the day after allergy consultation.
This project was undertaken as a practice improvement initiative. The study was supported by a practice improvement grant from
Results
Sixty patients (29 men and 31 women) with a mean age of 62 years (range, 16–89 years) were referred and evaluated in the study period. Twelve orthopedic surgeons referred patients to the study, 2 of whom referred 28 (47%) of the patients. Fifty-three patients (88%) were evaluated on the same day they were referred, and 7 (12%) had appointments other than the day of referral. Of the 60 patients, 48 gave a history of penicillin allergy, 2 gave a history of cephalosporin allergy, 5 had a history
Discussion
This report demonstrates that penicillin allergy testing and allergy consultation can reduce vancomycin use in patients with a history of penicillin allergy. A similar study showed that penicillin allergy skin testing can modify antibiotic use in 95% of patients with a prior history of penicillin allergy.15 Our observation that 93% of patients with a history of penicillin allergy had negative penicillin test results is similar to other reports. 11, 12
Previous reports also have shown that
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2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :For example, if a patient presents to a hip arthroscopy clinic with an elevated body mass index, an allergy to opioid medications, and a preoperative duration of symptoms equating to 1 year, using the current model will allow a hip arthroscopist to recommend weight loss and to consider drug desensitization within 1 year (since symptom duration of 2 years is a risk factor) to increase their probability of achieving clinically significant improvements in general function. Although not widely studied, previous literature has suggested that it is feasible and safe to implement weight loss and targeted allergy interventions before orthopaedic procedures,54,55 which may result in improved function and fewer adverse events.55,56 These optimization protocols may become incorporated as standard pathways as value-based care continues to develop.
Penicillin and Beta-Lactam Hypersensitivity
2017, Immunology and Allergy Clinics of North AmericaScreening for Beta-Lactam Allergy in Joint Arthroplasty Patients to Improve Surgical Prophylaxis Practice
2017, Journal of ArthroplastyCitation Excerpt :A preliminary review of the percent usage of non-beta-lactam antibiotics at our institution before and after drug allergy screening demonstrated a decrease which was consistent with published literature. Li et al [10] in their study of 60 orthopedic patients with HOBA demonstrated that 6 of 55 (11%) patients who had undergone penicillin allergy skin testing and subsequent surgery received vancomycin compared to 38 of 127 (30%) of historical controls. Park et al [8] also reported a benefit of a preoperative allergy clinic in reducing vancomycin for prophylaxis purposes in patients with HOBA and showed a decline in vancomycin use from 30%-16% in their study of 1111 patients following their intervention.