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The association of penicillin allergy with outcomes after open ventral hernia repair

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Up to 11% of patients report a penicillin allergy (PA), with 1–2% demonstrating a true IgE mediated allergy upon testing. PA patients often receive non-beta-lactam antibiotic surgical prophylaxis (non-BLP). This study evaluates the relationship of PA to outcomes after open ventral hernia repair (OVHR).

Methods

A prospective institutional database was queried for patients undergoing OVHR. Demographics, operative characteristics, and outcomes were evaluated by the reported PA and the administration of beta-lactam prophylaxis (BLP).

Results

Allergy histories were reviewed in 1178 patients. PA was reported in 21.6% of patients, with 55.5% reporting rash or hives, 15.0% airway compromise or anaphylaxis, and 29.5% no specific reaction. BLP was administered to 76.3% of patients, including 22.1% of PA patients and 89.9% of patients without PA. PA patients were more often female (64.6% PA patients vs. 56% non-PA, p = 0.01), with higher rates of chronic steroids, MRSA, anxiety, asthma, COPD, chronic pain, and sleep apnea (p < 0.03 all values). PA patients had higher rates of contaminated cases, including mesh infection and fistula. Of the 683 clean cases, 82.1% received BLP. Of the 117 clean contaminated cases (CDC wound class 2), 82.9% received BLP, which was associated with reduced long-term readmission for hernia complications (21.5 vs. 55%, p = 0.002, OR 0.27, CI 0.09–0.83). In the 120 CDC wound class 3 and 4 patients, 65.8% received BLP. In multivariate analysis, BLP was associated with lower rates of reoperation (OR 0.31, CI 0.12–0.76) and recurrence (OR 0.32, CI 0.11–0.86). BLP was given to 22.1% of the PA patients with no adverse reactions noted.

Conclusion

PA patients had more comorbidities and complex ventral hernias. When controlling for contamination and MRSA history, BLP is associated with improved outcomes particularly in contaminated cases. PA may be a risk factor for patient complexity, and further studies are warranted to determine if allergy testing can be warranted in known or anticipated contaminated cases.

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References

  1. Cox TC, Blair LJ, Huntington CR, Colavita PD, Prasad T, Lincourt AE, Heniford BT, Augenstein VA (2016) The cost of preventable comorbidities on wound complications in open ventral hernia repair. J Surg Res 206:214–222. https://doi.org/10.1016/j.jss.2016.08.009

    Article  PubMed  Google Scholar 

  2. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183. https://doi.org/10.1007/s10029-011-0879-9

    Article  CAS  PubMed  Google Scholar 

  3. Huntington C, Gamble J, Blair L, Cox T, Prasad T, Lincourt A, Augenstein V, Heniford BT (2016) Quantification of the effect of diabetes mellitus on ventral hernia repair: results from two national registries. Am Surg 82:661–671

    PubMed  Google Scholar 

  4. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA, American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Surgical Infection Society (SIS), Society for Healthcare Epidemiology of America (SHEA) (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 14:73–156. https://doi.org/10.1089/sur.2013.9999

    Article  Google Scholar 

  5. Chen JR, Tarver SA, Alvarez KS, Wei W, Khan DA (2018) Improving aztreonam stewardship and cost through a penicillin allergy testing clinical guideline. Open forum Infect Dis 5:ofy106. https://doi.org/10.1093/ofid/ofy106

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mattingly TJ, Fulton A, Lumish RA, Williams AMC, Yoon S, Yuen M, Heil EL (2018) The cost of self-reported penicillin allergy: a systematic review. J allergy Clin Immunol Pract 6:1649–1654. https://doi.org/10.1016/j.jaip.2017.12.033

    Article  PubMed  Google Scholar 

  7. Beltran RJ, Kako H, Chovanec T, Ramesh A, Bissonnette B, Tobias JD (2015) Penicillin allergy and surgical prophylaxis: cephalosporin cross-reactivity risk in a pediatric tertiary care center. J Pediatr Surg 50:856–859. https://doi.org/10.1016/j.jpedsurg.2014.10.048

    Article  PubMed  Google Scholar 

  8. Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi HK (2018) Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ 361:k2400. https://doi.org/10.1136/bmj.k2400

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pool C, Kass J, Spivack J, Nahumi N, Khan M, Babus L, Teng MS, Genden EM, Miles BA (2016) Increased surgical site infection rates following clindamycin use in head and neck free tissue transfer. Otolaryngol Neck Surg 154:272–278. https://doi.org/10.1177/0194599815617129

    Article  Google Scholar 

  10. Macy E, Contreras R (2015) Adverse reactions associated with oral and parenteral use of cephalosporins: a retrospective population-based analysis. J Allergy Clin Immunol 135:745–752. https://doi.org/10.1016/j.jaci.2014.07.062

    Article  CAS  PubMed  Google Scholar 

  11. Murphy J, Isaiah A, Dyalram D, Lubek JE (2017) Surgical site infections in patients receiving osteomyocutaneous free flaps to the head and neck. does choice of antibiotic prophylaxis matter? J Oral Maxillofac Surg 75:2223–2229. https://doi.org/10.1016/j.joms.2017.02.006

    Article  PubMed  Google Scholar 

  12. Blumenthal KG, Ryan EE, Li Y, Lee H, Kuhlen JL, Shenoy ES (2018) The impact of a reported penicillin allergy on surgical site infection risk. Clin Infect Dis 66:329–336. https://doi.org/10.1093/cid/cix794

    Article  PubMed  Google Scholar 

  13. Trubiano JA, Adkinson NF, Phillips EJ (2017) Penicillin allergy is not necessarily forever. JAMA 318:82–83. https://doi.org/10.1001/jama.2017.6510

    Article  PubMed  PubMed Central  Google Scholar 

  14. Raja AS, Lindsell CJ, Bernstein JA, Codispoti CD, Moellman JJ (2009) The use of penicillin skin testing to assess the prevalence of penicillin allergy in an emergency department setting. Ann Emerg Med 54:72–77. https://doi.org/10.1016/j.annemergmed.2008.12.034

    Article  PubMed  Google Scholar 

  15. Park M, Markus P, Matesic D, Li JTCC (2006) Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy. Ann Allergy Asthma Immunol 97:681–687. https://doi.org/10.1016/S1081-1206(10)61100-3

    Article  CAS  PubMed  Google Scholar 

  16. McDanel DL, Azar AE, Dowden AM, Murray-Bainer S, Noiseux NO, Willenborg M, Clark CR, Callaghan JJ, Haleem A (2017) Screening for beta-lactam allergy in joint arthroplasty patients to improve surgical prophylaxis practice. J Arthroplasty 32:S101–S108. https://doi.org/10.1016/j.arth.2017.01.012

    Article  PubMed  Google Scholar 

  17. Epstein RH, St Jacques P, Wanderer JP, Bombulie MR, Agarwalla N (2016) Prophylactic antibiotic management of surgical patients noted as “allergic” to penicillin at two academic hospitals. A A Case Rep 6:263–267. https://doi.org/10.1213/XAA.0000000000000253

    Article  PubMed  Google Scholar 

  18. Campagna JD, Bond MC, Schabelman E, Hayes BD (2012) The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med 42:612–620. https://doi.org/10.1016/j.jemermed.2011.05.035

    Article  PubMed  Google Scholar 

  19. Pichichero ME (2005) A review of evidence supporting the American Academy of pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics 115:1048–1057. https://doi.org/10.1542/peds.2004-1276

    Article  PubMed  Google Scholar 

  20. Shenoy ES, Macy E, Rowe T, Blumenthal KG (2019) Evaluation and management of penicillin allergy. JAMA 321:188. https://doi.org/10.1001/jama.2018.19283

    Article  PubMed  Google Scholar 

  21. Tsuchiya K, Shiho O, Kondo M (1979) Immunological cross-reactivities of sulfocephalosporins. J Antibiot (Tokyo) 32:488–495

    Article  CAS  Google Scholar 

  22. Solensky R, Earl HS, Gruchalla RS (2002) Lack of penicillin resensitization in patients with a history of penicillin allergy after receiving repeated penicillin courses. Arch Intern Med 162:822–826

    Article  Google Scholar 

  23. Haslam S, Yen D, Dvirnik N, Engen D (2012) Cefazolin use in patients who report a non-IgE mediated penicillin allergy: a retrospective look at adverse reactions in arthroplasty. Iowa Orthop J 32:100–103

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Goodman EJ, Morgan MJ, Johnson PA, Nichols BA, Denk N, Gold BB (2001) Cephalosporins can be given to penicillin-allergic patients who do not exhibit an anaphylactic response. J Clin Anesth 13:561–564

    Article  CAS  Google Scholar 

  25. Gadde J, Spence M, Wheeler B, Adkinson NF (1993) Clinical experience with penicillin skin testing in a large inner-city STD clinic. JAMA 270:2456–2463

    Article  CAS  Google Scholar 

  26. Tan TL, Springer BD, Ruder JA, Ruffolo MR, Chen AF (2016) Is vancomycin-only prophylaxis for patients with penicillin allergy associated with increased risk of infection after arthroplasty? Clin Orthop Relat Res 474:1601–1606. https://doi.org/10.1007/s11999-015-4672-4

    Article  PubMed  Google Scholar 

  27. Macy E, Contreras R (2014) Health care use and serious infection prevalence associated with penicillin &quot;allergy&quot; in hospitalized patients: a cohort study. J Allergy Clin Immunol 133:790–796. https://doi.org/10.1016/j.jaci.2013.09.021

    Article  PubMed  Google Scholar 

  28. Kronzer VL, Crowson CS, Sparks JA, Vassallo R, Davis JM (2019) Investigating asthma, allergic disease, passive smoke exposure, and risk of rheumatoid arthritis. Arthritis Rheumatol. https://doi.org/10.1002/art.40858

    Article  PubMed  Google Scholar 

  29. Kheir MM, Tan TL, Azboy I, Tan DD, Parvizi J (2017) Vancomycin prophylaxis for total joint arthroplasty: incorrectly dosed and has a higher rate of periprosthetic infection than cefazolin. Clin Orthop Relat Res 475:1767–1774. https://doi.org/10.1007/s11999-017-5302-0

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hawn MT, Richman JS, Vick CC, Deierhoi RJ, Graham LA, Henderson WG, Itani KMF (2013) Timing of surgical antibiotic prophylaxis and the risk of surgical site infection. JAMA Surg 148:649. https://doi.org/10.1001/jamasurg.2013.134

    Article  CAS  PubMed  Google Scholar 

  31. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP (2017) Centers for disease control and prevention guideline for the prevention of surgical Site infection, 2017. JAMA Surg 152:784. https://doi.org/10.1001/jamasurg.2017.0904

    Article  PubMed  Google Scholar 

  32. Baucom RB, Ousley J, Oyefule OO, Stewart MK, Phillips SE, Browman KK, Sharp KW, Holzman MD, Poulose BK (2016) Evaluation of long-term surgical site occurrences in ventral hernia repair: implications of preoperative site independent MRSA infection. Hernia 20:701–710. https://doi.org/10.1007/s10029-016-1523-5

    Article  CAS  PubMed  Google Scholar 

  33. Sakoulas G, Geriak M, Nizet V (2019) Is a reported penicillin allergy sufficient grounds to forgo the multidimensional antimicrobial benefits of β-lactam antibiotics? Clin Infect Dis 68:157–164. https://doi.org/10.1093/cid/ciy557

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA

    Kathryn A. Schlosser, Sean R. Maloney, James M. Horton, Tanushree Prasad, Paul D. Colavita, B. Todd Heniford & Vedra A. Augenstein

  2. Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    Vedra A. Augenstein

Authors
  1. Kathryn A. Schlosser
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  2. Sean R. Maloney
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  3. James M. Horton
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Corresponding author

Correspondence to Vedra A. Augenstein.

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Disclosures

Paul D Colavita MD is a speaker for Allergan. B Todd Heniford MD is a speaker for allergan, performs education and research with stryker, and is on an advisory committee for WL Gore. Vedra A Augenstein MD is a speaker for Allergan, Intuitive, Acelity, and WL Gore. Authors Kathryn A Schlosser MD, Sean R Maloney MD, JM Horton, and Tanushree Prasad MA have no conflicts of interest or financial ties to disclose.

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Schlosser, K.A., Maloney, S.R., Horton, J.M. et al. The association of penicillin allergy with outcomes after open ventral hernia repair. Surg Endosc 34, 4148–4156 (2020). https://doi.org/10.1007/s00464-019-07183-1

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