From the Journals

Preoperative penicillin allergy tests could decrease SSI


Key clinical point: Patients with reported penicillin allergies are at higher risk of developing a surgical site infection.

Major finding: Having a penicillin allergy was associated with a 50% increased risk of developing a surgical site infection, compared with those without the allergy (adjusted odds ratio, 1.5; P = .04).

Study details: Retrospective cohort study of 8,385 patients operated on at Massachusetts General Hospital, Boston, during 2010-2014.

Disclosures: The research was supported by the National Institutes of Health, and the investigators reported having no relevant conflicts.

Source: Blumenthal K et al. Clin Infect Dis. 2018 Jan 18;66(3):329-36.



Patients with reported penicillin allergies are significantly more likely to develop surgical site infections, according to a study conducted at Massachusetts General Hospital in Boston.

With new evidence reporting 90%-99% of patients with a reported allergy are not actually allergic, conducting a preoperative allergy test could improve treatment choice and decrease the risk of SSI, as well as the notable financial burden associated with it. Thus, “systematic, preoperative penicillin allergy evaluations in surgical patients may not only improve antibiotic choice but also decrease SSI risk,” according to Kimberly Blumenthal, MD, the quality director for the department of allergy and immunology at Massachusetts General Hospital, and her fellow investigators.

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Their retrospective study included 8,385 patients admitted to Massachusetts General Hospital during 2010-2014. The average age was 64 years, the majority were white (85%), and 22.9% of patients in the study were diagnosed with cardiovascular disease.

Surgeries performed were hip arthroplasty, knee arthroplasty, hysterectomy, colon surgery, or coronary artery bypass grafting.

Of the patients studied, 922 (11%) reported a penicillin allergy; most had minor reactions, such as rashes (37.5%) or urticaria (18%). “Only 5 reactions to penicillin represented contraindications to receiving a beta-lactam; the vast majority of patients would have tolerated first-line recommended cephalosporin prophylaxis had allergy evaluation been pursued,“ according to Dr. Blumenthal and her colleagues.

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