title: Screening for Beta-Lactam Allergy in Joint Arthroplasty Patients to Improve Surgical Prophylaxis Practice.
abstract: The reliability of patient-reported penicillin allergies has been disputed. A Drug Allergy Clinic (DAC) was established at our institution in combination with an electronic best practice alert (BPA) in the Orthopedic Clinic. Joint arthroplasty patients with a reported history of beta-lactam allergy (HOBA) were preoperatively referred via the BPA to the DAC. The purpose of this study was to determine the effectiveness of beta-lactam allergy screening in enabling the surgical team to optimize antimicrobial prophylaxis.
  
  
  
  Between February 2013 and May 2015, 161 patients with a HOBA were referred to the DAC where they underwent penicillin skin testing (PST), a drug challenge to a beta-lactam antibiotic, and/or had no intervention depending on the history obtained.
  
  
  
  PST was performed on 140 of 161 (87%) patients. A negative PST was noted in 139 (99%) patients, indicating no penicillin allergy. Cefazolin was safe to use in 145 (90%) patients evaluated. Significantly more patients evaluated in the DAC vs those not seen got cefazolin in any surgical prophylaxis regimen (90% vs 77%) without any adverse perioperative reactions. Concurrently, the use of non-beta-lactam antibiotics was significantly less in the patients evaluated vs not evaluated (16% vs 27%). The overall use of cefazolin in orthopedic surgeries in patients with HOBA was >84% over the course of the study period.
  
  
  
  Beta-lactam allergy screening using a BPA and a DAC promotes the use of standard surgical prophylaxis with cefazolin. Joint arthroplasty surgeons should consider implementing allergy screening programs to promote antimicrobial stewardship.
authors.affiliation: Department of Pharmaceutical Care, University of Iowa Healthcare, Iowa City, Iowa; University of Iowa College of Pharmacy, Iowa City, Iowa.
authors.forename: Deanna L
authors.initials: DL
authors.lastname: McDanel
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, Iowa; University of Iowa Healthcare, Iowa City, Iowa; Johns Hopkins University, Baltimore, Maryland.
authors.forename: Antoine E
authors.initials: AE
authors.lastname: Azar
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, Iowa; University of Iowa Healthcare, Iowa City, Iowa.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Dowden
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, Iowa; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin.
authors.forename: Samantha
authors.initials: S
authors.lastname: Murray-Bainer
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Nicolas O
authors.initials: NO
authors.lastname: Noiseux
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Melissa
authors.initials: M
authors.lastname: Willenborg
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Clark
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, Iowa; Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa; Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin.
authors.forename: Ambar
authors.initials: A
authors.lastname: Haleem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents; D019072:Antibiotic Prophylaxis; D001178:Arthroplasty; D019643:Arthroplasty, Replacement; D002437:Cefazolin; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012882:Skin Tests; D047090:beta-Lactams / Q000276:immunology*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D010406:Penicillins; D047090:beta-Lactams; D002437:Cefazolin
keywords: allergy; beta-lactam; cefazolin; prophylaxis; screening; surgery