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J Antimicrob Chemother. 2017 Sep 1;72(9):2657-2660. doi: 10.1093/jac/dkx171.

Optimizing preoperative prophylaxis in patients with reported β-lactam allergy: a novel extension of antimicrobial stewardship.

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Division of Infectious Diseases, University Health Network, Toronto, Ontario M5G 2C4, Canada.
Division of Infectious Diseases, Michael Garron Hospital, Toronto East Health Network, Toronto, Ontario M4C 3E7, Canada.
Preoperative Assessment Clinic, Michael Garron Hospital, Toronto East Health Network, Toronto, Ontario M4C 3E7, Canada.



Use of alternative second-line antibiotics is associated with adverse events in patients reporting β-lactam allergy. In the perioperative setting, we hypothesized that structured allergy histories, without the use of skin testing, can reduce alternative prophylactic antibiotic use.


Assess the impact of structured allergy histories on patients with self-reported β-lactam allergy (SRBA) undergoing elective surgical procedures.


Structured allergy histories were performed by a pharmacist and reviewed with an infectious diseases physician. Patients were deemed safe to proceed with cefazolin prophylaxis if they did not describe a history of type I-mediated or severe reaction. Antibiotic prophylaxis orders (with approval by the surgical team) were scheduled into the computerized order entry system to be given prior to first incision of the operation.


Of the 485 patients with SRBA that underwent structured allergy histories, 117 (24.1%) reported a type I-mediated allergy history; 267 (55.1%) patients received cefazolin prophylaxis and none subsequently experienced an adverse reaction. After intervention implementation, the overall use of alternative antibiotic prophylaxis at Michael Garron Hospital (Toronto, Canada) among those with SRBA decreased from 81.9% to 55.9%. This drop was associated with the number of monthly assessments (P < 0.001) in a regression analysis.


Using a simple structured history and the principles of prospective audit and feedback, we were able to increase the use of cefazolin perioperative prophylaxis without any serious adverse events and in the absence of skin testing or diagnostic challenges.

[Indexed for MEDLINE]

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