Category: Professional Posters
Purpose: Approximately 10% of the United States population has a history of allergy to penicillin (HOAP) documented in their electronic medical record. True penicillin allergy is estimated to be 0.01%. Overdiagnosis of penicillin allergy has the potential to lead to inappropriate treatment with vancomycin, clindamycin, and fluoroquinolones. The purpose of this study is to evaluate the outcomes of penicillin skin testing on perioperative vancomycin use in total joint replacement orthopedic procedures.
Methods: This retrospective analysis included adult patients who had a total joint replacement surgery performed by a Marshfield Clinic Health System orthopedic surgeon. The implementation of penicillin skin testing and a flowchart to guide perioperative antibiotic use in patients with documented penicillin allergies was implemented on January 1, 2018 through December 1, 2018. Results were compared to a historical cohort. Data was gathered and analyzed to assess how many Marshfield Clinic Health System patients had a penicillin allergy recorded in their electronic medical record, including information on the type of documented reaction. The number of patients with a documented penicillin allergy who went on to receive penicillin skin testing was also assessed. The incidence of perioperative vancomycin use in total joint replacement orthopedic surgical patients was gathered as well as the frequency of updated penicillin allergy information in the electronic medical record in patients who had a negative penicillin skin test.
Results: In Marshfield Clinic Health System patients, 13.6% had a history of penicillin allergy documented in their electronic medical record. The most common documented reaction to penicillin was rash (40%) and hives (29%). Between January 1, 2018 and December 1, 2018, 15 patients with a documented penicillin allergy were referred to the allergy clinic for penicillin skin testing. Thirteen patients (87%) had a negative penicillin skin test and were candidates to receive cefazolin preoperatively instead of vancomycin. Perioperative vancomycin use was reduced after the implementation of a preoperative assessment and penicillin skin testing (4.2% vs 9.5%). In the thirteen patients who had a negative penicillin skin test, 10 patients had the penicillin allergy removed from their electronic medical record.
Conclusion: The incidence of medical health record documented penicillin allergies at our health care system was similar to the national average of 10-20%. The implementation of penicillin skin testing and a guidance flowchart helped to aid provider prescribing of perioperative antibiotics in patients with documented penicillin allergies and reduced vancomycin use in total joint orthopedic procedures. Future directions will include evaluating the feasibility of extending penicillin skin testing to all patients scheduled to receive an orthopedic procedure.