Penicillin Allergy Assessment and Skin Testing (PAAST) in Outpatient Orthopedic Clinics Brittany S. Morrow, P. Brandon Bookstaver, Hana Rac, Julie Justo, Frank Vos Palmetto Health Richland/University of South Carolina College of Pharmacy (Infectious Diseases) - Columbia, SC
Background/Purpose: Allergic reactions to beta-lactam antibiotics, such as penicillins and cephalosporins, are reported in 10% of the overall population, although as many as 90% may be inappropriately labeled. As a result, patients are prescribed alternative, non-preferred antibiotics leading to increased drug related adverse events, opportunistic infections such as Clostridioides difficile infection and surgical site infections. Use of a penicillin allergy assessment and skin testing (PAAST) program has increased appropriate utility of preferred beta-lactam therapy, primarily in the inpatient setting. Expansion of PAAST to outpatient orthopedic clinics may improve antibiotic prescribing for surgical prophylaxis, mitigate the increased risk associated with alternative perioperative antimicrobial therapy, and optimize operating room workflow.
Methodology: This study is a single-center, observational, concurrent retrospective and prospective cohort study. The medical records of all adult patients scheduled for elective hip or knee surgery at Prisma Health_x0014_Midlands Orthopedic clinics from November 1, 2016 _x0013_ March 31, 2017, pre-implementation period of PAAST protocol, and November 26, 2018 -- March31, 2019 , post-implementation period of PAAST protocol, will be screened for inclusion. Patients are excluded if records with required data points are unavailable. The primary endpoint is percentage of patients prescribed guideline recommended cefazolin for surgical prophylaxis in the pre-implementation period compared to the post-implementation period. Descriptive statistics, will be used to summarize the primary outcome; t-test and chi-squared will be used for comparison as appropriate.
Presentation Objective: To assess the impact of allergy reconciliation and skin testing of self-reported penicillin allergies on preferred, prophylactic antibiotic use in patients undergoing elective outpatient hip or knee orthopedic surgery.
Self-Assessment: How does appropriate allergy reconciliation and skin testing impact the prescribing practice of antibiotic prophylactic options?
