Safety of Cefazolin for Perioperative Prophylaxis in Patients with Penicillin Allergy Labels.

Cefazolin is a first-line antibiotic for perioperative prophylaxis of surgical site infections. 1 Moussa Y, Shuster J, Matte G, Sullivan A, Goldstein RH, Cunningham D, et al. De-labeling of β-lactam allergy reduces intraoperative time and optimizes choice in antibiotic prophylaxis [e-pub ahead of print]. Surgery. https://doi.org/10.1016/j.surg.2018.03.004. Accessed November 1, 2021. Google Scholar Between 8% and 15% of the US population have penicillin allergy labels (PAL). 2 Stone CA Stollings JL Lindsell CJ Dear ML Buie RB Rice TW et al. Risk-stratified management to remove low-risk penicillin allergy labels in the ICU. Am J Respir Crit Care Med. 2020; 201: 1572-1575 Crossref PubMed Scopus (19) Google Scholar Patients with PAL receive perioperative cefazolin less frequently and are more likely to receive alternative antibiotics, increasing their risk of surgical site infection. 1 Moussa Y, Shuster J, Matte G, Sullivan A, Goldstein RH, Cunningham D, et al. De-labeling of β-lactam allergy reduces intraoperative time and optimizes choice in antibiotic prophylaxis [e-pub ahead of print]. Surgery. https://doi.org/10.1016/j.surg.2018.03.004. Accessed November 1, 2021. Google Scholar This practice is likely from overestimating the risk of cross-reactivity between penicillin and cephalosporins. Cross-reactivity among these antibiotics is thought to be from a common R1 side chain, absent in cefazolin. Recent studies have found that cross-reactions rarely occur. 3 Sousa-Pinto B Blumenthal KG Courtney L Mancini CM Jeffres MN. Assessment of the frequency of dual allergy to penicillins and cefazolin: a systematic review and meta-analysis. JAMA Surg. 2021; 156e210021 Crossref Scopus (11) Google Scholar In a meta-analysis, the rate of cross-reactivity of penicillin with cefazolin was 0.7%. 4 Zagursky RJ Pichichero ME. Cross-reactivity in β-lactam allergy. J Allergy Clin Immunol Pract. 2018; 6: 72-81 Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar Furthermore, PALs often include intolerances, adverse effects, or reported childhood allergies, which often resolve by adulthood. 3 Sousa-Pinto B Blumenthal KG Courtney L Mancini CM Jeffres MN. Assessment of the frequency of dual allergy to penicillins and cefazolin: a systematic review and meta-analysis. JAMA Surg. 2021; 156e210021 Crossref Scopus (11) Google Scholar We hypothesize that cefazolin is safe to use in most patients with PAL. In this study, we aim to learn on the use of cefazolin in patients with PALs, a population typically encountered by clinicians in the perioperative setting who may not have confirmed immunoglobulin E–mediated penicillin allergies.