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Maisat W, Bermudez M, Yuki K. Use of clindamycin as an alternative antibiotic prophylaxis. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2022; 28:100278. [PMID: 35873080 PMCID: PMC9306335 DOI: 10.1016/j.pcorm.2022.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Clindamycin serves as an alternative surgical prophylactic antibiotic in patients with penicillin (PCN) or cephalosporin allergy labels. In the previous reports, the use of clindamycin was associated with higher incidences of surgical site infections (SSIs). We aimed to determine the characteristics of PCN or cephalosporin allergic reactions to stratify patient's risk and indicate subsequent management; leading to de-labeling of PCN or cephalosporin allergy. METHODS We conducted a prospective cohort study of patients receiving clindamycin as surgical antibiotic prophylaxis from September 2021 to March 2022. Data were collected from electronic medical records; included demographic data, antibiotic allergy labels, allergic reaction, and allergy testing. RESULTS Clindamycin was administered in 445 patients who underwent 451 operations. Among these patients, 53.0% (n = 236) were female with a median age of 15 years (range; 0.5-57.0 years). PCN and cephalosporin allergies were labelled in 83.8% (n = 373) and 25.6% (n = 114) patients, respectively; 11.4% (n = 51) of patients were allergic to both classes of the antibiotics. There were 191 (51.2%) and 73 (64.0%) possible hypersensitivity reactions (HSRs) in PCN and cephalosporin groups, respectively. The most common reactions were rash (PCN: n = 99, 26.5%; cephalosporin: n = 35, 30.7%), and hives (PCN: n = 71, 19.0%; cephalosporin: n = 24, 21.1%). Severe reactions included angioedema (PCN: n = 7, 1.9%; cephalosporin: n = 5, 4.4%), anaphylaxis (PCN: n = 8, 2.1%; cephalosporin: n = 7, 6.1%), bronchospasm (cephalosporin: n = 1, 0.9%), airway involvement (PCN: n = 1, 0.3%; cephalosporin: n = 1, 0.9%), serum sickness (PCN: n = 1, 0.3%), blisters (PCN: n = 1, 0.3%), and drug reaction with eosinophilia and systemic symptoms (DRESS) (PCN: n = 1, 0.3%). Low-risk history of allergy included gastrointestinal side effects (PCN: n = 9, 2.4%; cephalosporin: n = 3, 2.7%), positive family history (PCN: n = 7, 1.9%; cephalosporin: n = 1, 0.9%), and remote history of allergy (PCN: n = 2, 0.5%). There were 201 (53.9%) and 53 (46.5%) unknown reactions in PCN and cephalosporin groups, respectively. In the overall cohort, 3 patients (0.7%) were skin tested for drug allergy (PCN: n = 2, 0.5%; cephalosporin: n = 2, 1.8%). CONCLUSION Clindamycin was largely administered in patients with non-severe HSRs, low-risk history or unknown reactions to PCN or cephalosporin, whom cefazolin could have been administered safely. Obtaining a detailed history of antibiotic allergy, allergy testing and/or direct oral challenge can de-label unsubstantiated PCN or cephalosporin allergy and ultimately reduce the incidence of SSIs by optimizing the rate of more effective antibiotic administration.
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Affiliation(s)
- Wiriya Maisat
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, United States of America
- Department of Anaesthesia, Harvard Medical School, Boston, United States of America
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marie Bermudez
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, United States of America
| | - Koichi Yuki
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, United States of America
- Department of Anaesthesia, Harvard Medical School, Boston, United States of America
- Department of Immunology, Harvard Medical School, Boston, United States of America
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Shibamura-Fujiogi M, Ormsby J, Breibart M, Warf B, Priebe GP, Soriano SG, Sandora TJ, Yuki K. Risk factors for pediatric surgical site infection following neurosurgical procedures for hydrocephalus: a retrospective single-center cohort study. BMC Anesthesiol 2021; 21:124. [PMID: 33882858 PMCID: PMC8059169 DOI: 10.1186/s12871-021-01342-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Infection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. However, pediatric risk factors for surgical site infection (SSI) are currently not well defined. Because a SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries following a SSI bundle at a single quaternary care pediatric hospital. Methods We performed a retrospective cohort study of patients undergoing CSF diversion procedures from 2017 to 2019. SSIs were identified prospectively through continuous surveillance. We performed unadjusted logistic regression analyses and univariate analyses to determine an association between SSIs and patient demographics, comorbidities and perioperative factors to identify independent risk factors for SSI. Results We identified a total of 558 CSF diversion procedures with an overall SSI rate of 3.4%. The SSI rates for shunt, external ventricular drain (EVD) placement, and endoscopic third ventriculostomy (ETV) were 4.3, 6.9 and 0%, respectively. Among 323 shunt operations, receipt of clindamycin as perioperative prophylaxis and presence of cardiac disease were significantly associated with SSI (O.R. 4.99, 95% C.I. 1.27–19.70, p = 0.02 for the former, and O.R. 7.19, 95% C.I. 1.35–38.35, p = 0.02 for the latter). No risk factors for SSI were identified among 72 EVD procedures. Conclusion We identified receipt of clindamycin as perioperative prophylaxis and the presence of cardiac disease as risk factors for SSI in shunt procedures. Cefazolin is recommended as a standard antibiotic for perioperative prophylaxis. Knowing that unsubstantiated beta-lactam allergy label is a significant medical problem, efforts should be made to clarify beta-lactam allergy status to maximize the number of patients who can receive cefazolin for prophylaxis before shunt placement. Further research is needed to elucidate the mechanism by which cardiac disease may increase SSI risk after shunt procedures.
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Affiliation(s)
- Miho Shibamura-Fujiogi
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Anaesthesia, Harvard Medical School, Boston, USA.,Department of Immunology, Harvard Medical School, Boston, USA
| | - Jennifer Ormsby
- Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, USA
| | - Mark Breibart
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Benjamin Warf
- Department of Neurosurgery, Boston Children's Hospital, Boston, USA
| | - Gregory P Priebe
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Anaesthesia, Harvard Medical School, Boston, USA.,Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, USA
| | - Sulpicio G Soriano
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Anaesthesia, Harvard Medical School, Boston, USA
| | - Thomas J Sandora
- Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, USA.,Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Koichi Yuki
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Anaesthesia, Harvard Medical School, Boston, USA. .,Department of Immunology, Harvard Medical School, Boston, USA.
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Rottenstreich A, Levin G, Tsur A, Shai D, Meyer R. Chorioamnionitis at latent phase more than doubles the risk for cesarean delivery compared to chorioamnionitis at active phase. Arch Gynecol Obstet 2020; 303:905-910. [PMID: 32995917 DOI: 10.1007/s00404-020-05815-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Chorioamnionitis, or intraamniotic infection, is a common condition, carrying an increased risk of intrapartum cesarean delivery (CD). The morbidity related to chorioamnionitis is more common in those undergoing CD, as compared to those with successful vaginal delivery. We aimed to examine the risk factors associated with CD among women with chorioamnionitis. METHODS A retrospective cohort study from a tertiary medical center. We included women at term carrying a singleton gestation with suspected chorioamnionitis undergoing a trial of labor between 2011 and 2019. The primary outcome was the mode of delivery. RESULTS Data from 1436 women with chorioamnionitis were analyzed; 1288 (89.7%) were nulliparous. Overall, 1064 (74.1%) delivered vaginally, and 372 (25.9%) by CD. The rate of CD was significantly higher in nulliparous as compared to parous parturients (26.9% vs. 16.9%, P = 0.008), and in those with fever onset at latent phase as compared to those in whom fever appeared at active labor (≥ 6 cm) (47.0% vs. 18.1%, P < 0.001). In a multivariate analysis, CD was positively associated with: onset of fever at latent phase (aOR [95% CI] 4.75 (3.54, 6.32), P < 0.001), nulliparity (aOR [95% CI] 3.25 (1.98, 5.34), P < 0.001), maternal age (aOR [95% CI] 1.52 (1.10, 2.09), P = 0.01) and birth weight (aOR [95% CI] 1.23 (1.04, 1.44), P = 0.01). CONCLUSION Women with chorioamnionitis had a high rate of CD. Nulliparity and onset of fever prior to active labor were the strongest independent predictors of CD. It remains to be determined whether those deemed at high risk for failed trial of labor, should undergo CD earlier in the course of labor to improve chorioamnionitis-related outcomes.
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Affiliation(s)
- Amihai Rottenstreich
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abraham Tsur
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Daniel Shai
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel. .,The Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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