Antimicrobial stewardship may increase use of appropriate TJA prophylaxis
Click Here to Manage Email Alerts
Antibiotic stewardship may increase preferred prophylaxis and cefazolin use in patients with non-severe penicillin allergies who undergo total joint arthroplasty, according to recently presented results.
Raquel Roberts, PharmD, presented findings of a retrospective chart view on antibiotic stewardship initiatives and cefazolin tolerance at the Musculoskeletal Infection Society Annual Meeting. The meeting was held virtually.
“Several antimicrobial stewardship interventions occurred at our institution to increase the use of appropriate perioperative surgical prophylaxis and to expand the use of cefazolin in penicillin (PCN)-allergic patients,” Roberts said in her presentation. “These changes helped to ensure adherence to guidelines and consistency between surgeons. An orthopedic physician also served as a champion to educate their peers regarding guideline adherence,” she said.
Roberts and colleagues at University of Rochester Medicine identified 180 patients with PCN allergy who underwent elective total hip or total knee arthroplasty at Highland Hospital in Rochester, New York, from March 1, 2017 to Aug. 30, 2019. Ninety patients were analyzed for surgical site and Clostridioides difficile infections before intervention, and 90 patients were analyzed for infection after the intervention, according to the study.
“The primary outcome of our study was the difference in the composite rates of patients who received appropriate antibiotics,” Roberts said. “The composite is defined as the total patients with a reported non-severe PCN allergy with MRSA risk factors who received cefazolin plus vancomycin, those with non-severe allergies and no MRSA risk factors who received cefazolin, and patients with a severe PCN allergy who received vancomycin,” she added.
Roberts and colleagues found appropriate perioperative antibiotic use increased “significantly” from 54.5% to 90.8% after antimicrobial stewardship intervention, and no patients reported an allergic reaction due to cefazolin.
“Despite the high rates of patients with a reported penicillin allergy, the majority of patients – even those reporting hives or local swelling – can tolerate cefazolin without signs of allergic reactions,” Roberts said. “Antimicrobial stewardship initiatives are low-cost, easy to implement and can significantly increase the rate of appropriate prophylaxis,” she concluded.
Collapse
Roberts R, et al. Presentation 64. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 7-8, 2020 (virtual meeting).
Click Here to Manage Email Alerts