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906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study

BACKGROUND: Surgical site infections (SSIs) are a significant cause of morbidity and mortality. The administration of appropriate pre-operative antimicrobial prophylaxis (AMP) reduces SSI risk and beta-lactam antibiotics are considered the most effective agents. Studies in adult patients found incre...

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Autores principales: Huang, Felicia Scaggs, Mangeot, Colleen, Sucharew, Heidi, Simon, Katherine, Courter, Joshua D, Risma, Kimberly, Schaffzin, Joshua K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776742/
http://dx.doi.org/10.1093/ofid/ofaa439.1094
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author Huang, Felicia Scaggs
Mangeot, Colleen
Sucharew, Heidi
Simon, Katherine
Courter, Joshua D
Risma, Kimberly
Schaffzin, Joshua K
author_facet Huang, Felicia Scaggs
Mangeot, Colleen
Sucharew, Heidi
Simon, Katherine
Courter, Joshua D
Risma, Kimberly
Schaffzin, Joshua K
author_sort Huang, Felicia Scaggs
collection PubMed
description BACKGROUND: Surgical site infections (SSIs) are a significant cause of morbidity and mortality. The administration of appropriate pre-operative antimicrobial prophylaxis (AMP) reduces SSI risk and beta-lactam antibiotics are considered the most effective agents. Studies in adult patients found increased SSI risk in patients with documented beta-lactam allergy (BLA) due to use of second line AMP agents. The SSI risk in BLA pediatric patients is not well-described. METHODS: We conducted a retrospective matched cohort study of patients (1-19 years-old) who underwent a surgical procedure at a quaternary pediatric hospital during 2010-2017. Patients with documented BLA at the time of surgery were matched 1:1 to patients with no BLA by age at surgery, National Surgical Quality Improvement Program (NSQIP) category, surgical calendar year, and presence of complex chronic conditions (CCC). AMP by BLA status was considered appropriate if recommended by the 2013 American Society of Health-System Pharmacists (ASHP) guidelines, antibiotic class appropriate, or recommended by an infectious disease physician. McNemar’s test was used to assess differences in SSI rates and antibiotic regimen appropriate for BLA status between BLA and no BLA groups. RESULTS: Of the 11878 surgical procedures among 9781 patients during the study period, 1021(9%) of patients had a reported BLA and we matched 972. SSI was rare in both groups and there was no significant difference in rates (18 (1.9%) in no BLA, 17 (1.8%) in BLA, p=1.0). BLA were more likely to receive an antibiotic regimen considered inappropriate for BLA status (22%) compared to no BLA (3%) with 89% receiving a beta-lactam-containing AMP regimen (p< 0.01). CONCLUSION: BLA was not associated with increased SSI risk in the pediatric patients studied. Interestingly, a significant proportion of children with a documented allergy received a beta-lactam for AMP. This suggests some providers recognize that allergy labels are inaccurate and may be comfortable administering beta-lactam AMP regardless of allergy status. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-77767422021-01-07 906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study Huang, Felicia Scaggs Mangeot, Colleen Sucharew, Heidi Simon, Katherine Courter, Joshua D Risma, Kimberly Schaffzin, Joshua K Open Forum Infect Dis Poster Abstracts BACKGROUND: Surgical site infections (SSIs) are a significant cause of morbidity and mortality. The administration of appropriate pre-operative antimicrobial prophylaxis (AMP) reduces SSI risk and beta-lactam antibiotics are considered the most effective agents. Studies in adult patients found increased SSI risk in patients with documented beta-lactam allergy (BLA) due to use of second line AMP agents. The SSI risk in BLA pediatric patients is not well-described. METHODS: We conducted a retrospective matched cohort study of patients (1-19 years-old) who underwent a surgical procedure at a quaternary pediatric hospital during 2010-2017. Patients with documented BLA at the time of surgery were matched 1:1 to patients with no BLA by age at surgery, National Surgical Quality Improvement Program (NSQIP) category, surgical calendar year, and presence of complex chronic conditions (CCC). AMP by BLA status was considered appropriate if recommended by the 2013 American Society of Health-System Pharmacists (ASHP) guidelines, antibiotic class appropriate, or recommended by an infectious disease physician. McNemar’s test was used to assess differences in SSI rates and antibiotic regimen appropriate for BLA status between BLA and no BLA groups. RESULTS: Of the 11878 surgical procedures among 9781 patients during the study period, 1021(9%) of patients had a reported BLA and we matched 972. SSI was rare in both groups and there was no significant difference in rates (18 (1.9%) in no BLA, 17 (1.8%) in BLA, p=1.0). BLA were more likely to receive an antibiotic regimen considered inappropriate for BLA status (22%) compared to no BLA (3%) with 89% receiving a beta-lactam-containing AMP regimen (p< 0.01). CONCLUSION: BLA was not associated with increased SSI risk in the pediatric patients studied. Interestingly, a significant proportion of children with a documented allergy received a beta-lactam for AMP. This suggests some providers recognize that allergy labels are inaccurate and may be comfortable administering beta-lactam AMP regardless of allergy status. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7776742/ http://dx.doi.org/10.1093/ofid/ofaa439.1094 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Huang, Felicia Scaggs
Mangeot, Colleen
Sucharew, Heidi
Simon, Katherine
Courter, Joshua D
Risma, Kimberly
Schaffzin, Joshua K
906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study
title 906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study
title_full 906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study
title_fullStr 906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study
title_full_unstemmed 906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study
title_short 906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study
title_sort 906. surgical site infections in children with beta-lactam allergy: a matched cohort study
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776742/
http://dx.doi.org/10.1093/ofid/ofaa439.1094
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