Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery
Abstract Objective: Up to 10% of patients report penicillin allergy (PA), although only 1% are truly affected by Ig-E-mediated allergies. PA has been associated with worse postoperative outcomes, but studies on the impact of reported PA in cancer patients are lacking, and especially in these multi...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2023-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X23005016/type/journal_article |
| _version_ | 1797392696192532480 |
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| author | Nico Christian Grossmann Yves Kersting Andres Affentranger Luca Antonelli Fabian Joel Aschwanden Philipp Baumeister Gerhard Müllner Marco Rossi Agostino Mattei Christian Daniel Fankhauser |
| author_facet | Nico Christian Grossmann Yves Kersting Andres Affentranger Luca Antonelli Fabian Joel Aschwanden Philipp Baumeister Gerhard Müllner Marco Rossi Agostino Mattei Christian Daniel Fankhauser |
| author_sort | Nico Christian Grossmann |
| collection | DOAJ |
| description |
Abstract
Objective:
Up to 10% of patients report penicillin allergy (PA), although only 1% are truly affected by Ig-E-mediated allergies. PA has been associated with worse postoperative outcomes, but studies on the impact of reported PA in cancer patients are lacking, and especially in these multimorbid patients, a non-complicated course is of utmost importance.
Methods:
Retrospective analysis of patients undergoing elective oncological surgery at a tertiary reference center. Data on surgical site infections (SSI), postoperative complications (measured by Clavien-Dindo classification and Comprehensive Complication Index (CCI)), hospitalization duration, and treatment costs were collected.
Results:
Between 09/2019 and 03/2020, 152 patients were identified. 16/152 patients (11%) reported PA, while 136/152 (89%) did not. There were no differences in age, BMI, Charlson Comorbidity Index, and smoking status between groups (p > 0.4). Perioperative beta-lactam antibiotics were used in 122 (89.7%) and 15 (93.8%) patients without and with reported PA, respectively. SSI and mean numbers of infections occurred non-significantly more often in patients with PA (p = 0.2 and p = 0.47). The median CCI was significantly higher in PA group (26 vs. 51; p = 0.035). The median hospitalization duration and treatment costs were similar between non-PA and PA groups (4 vs 3 days, p = 0.8; 16’818 vs 17’444 CHF, p = 0.4).
Conclusions:
In patients undergoing cancer surgery, reported PA is common. Failure to question the unproven PA may impair perioperative outcomes. For this reason, patient and provider education on which reactions constitute a true allergy would also assist in allergy de-labeling. In addition, skin testing and oral antibiotic challenges can be performed to identify the safe antibiotics and to de-label appropriate patients.
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| first_indexed | 2024-03-08T23:52:14Z |
| format | Article |
| id | doaj.art-dddb6a256eac409582bc9ad225b2c281 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-03-08T23:52:14Z |
| publishDate | 2023-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-dddb6a256eac409582bc9ad225b2c2812023-12-13T11:05:00ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2023-01-01310.1017/ash.2023.501Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgeryNico Christian Grossmann0https://orcid.org/0000-0001-8698-6461Yves Kersting1Andres Affentranger2https://orcid.org/0000-0002-6685-2180Luca Antonelli3https://orcid.org/0000-0001-6067-5497Fabian Joel Aschwanden4Philipp Baumeister5Gerhard Müllner6Marco Rossi7Agostino Mattei8Christian Daniel Fankhauser9https://orcid.org/0000-0002-4073-5488Department of Urology, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Urology, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Urology, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Urology, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Urology, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Urology, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Dermatology and Allergology, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Infectious Diseases, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Urology, Kantonsspital Luzern, Lucerne, SwitzerlandDepartment of Urology, Kantonsspital Luzern, Lucerne, Switzerland University of Zurich, Zurich, Switzerland University of Lucerne, Lucerne, Switzerland Abstract Objective: Up to 10% of patients report penicillin allergy (PA), although only 1% are truly affected by Ig-E-mediated allergies. PA has been associated with worse postoperative outcomes, but studies on the impact of reported PA in cancer patients are lacking, and especially in these multimorbid patients, a non-complicated course is of utmost importance. Methods: Retrospective analysis of patients undergoing elective oncological surgery at a tertiary reference center. Data on surgical site infections (SSI), postoperative complications (measured by Clavien-Dindo classification and Comprehensive Complication Index (CCI)), hospitalization duration, and treatment costs were collected. Results: Between 09/2019 and 03/2020, 152 patients were identified. 16/152 patients (11%) reported PA, while 136/152 (89%) did not. There were no differences in age, BMI, Charlson Comorbidity Index, and smoking status between groups (p > 0.4). Perioperative beta-lactam antibiotics were used in 122 (89.7%) and 15 (93.8%) patients without and with reported PA, respectively. SSI and mean numbers of infections occurred non-significantly more often in patients with PA (p = 0.2 and p = 0.47). The median CCI was significantly higher in PA group (26 vs. 51; p = 0.035). The median hospitalization duration and treatment costs were similar between non-PA and PA groups (4 vs 3 days, p = 0.8; 16’818 vs 17’444 CHF, p = 0.4). Conclusions: In patients undergoing cancer surgery, reported PA is common. Failure to question the unproven PA may impair perioperative outcomes. For this reason, patient and provider education on which reactions constitute a true allergy would also assist in allergy de-labeling. In addition, skin testing and oral antibiotic challenges can be performed to identify the safe antibiotics and to de-label appropriate patients. https://www.cambridge.org/core/product/identifier/S2732494X23005016/type/journal_article |
| spellingShingle | Nico Christian Grossmann Yves Kersting Andres Affentranger Luca Antonelli Fabian Joel Aschwanden Philipp Baumeister Gerhard Müllner Marco Rossi Agostino Mattei Christian Daniel Fankhauser Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery |
| title_full | Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery |
| title_fullStr | Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery |
| title_full_unstemmed | Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery |
| title_short | Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery |
| title_sort | prevalence of reported penicillin allergy and associations with perioperative complications length of stay and cost in patients undergoing elective cancer surgery |
| url | https://www.cambridge.org/core/product/identifier/S2732494X23005016/type/journal_article |
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