{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:22:56Z","timestamp":1791872576175,"version":"4.3.4"},"reference-count":24,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T00:00:00Z","timestamp":1629072000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X2100310X_as1\"><jats:title>Objective:<\/jats:title><jats:p>To evaluate whether a series of quality improvement interventions to promote safe perioperative use of cephalosporins in penicillin-allergic patients improved use of first-line antibiotics and decreased costs.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2100310X_as2\"><jats:title>Design:<\/jats:title><jats:p>Before-and-after trial following several educational interventions.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2100310X_as3\"><jats:title>Setting:<\/jats:title><jats:p>Academic medical center.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2100310X_as4\"><jats:title>Patients:<\/jats:title><jats:p>This study included patients undergoing a surgical procedure involving receipt of a perioperative antibiotic other than a penicillin or carbapenem between January 1, 2017, and August 31, 2019. Patients with and without a penicillin allergy label in their electronic medical record were compared with respect to the percentage who received a cephalosporin and average antibiotic cost per patient.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2100310X_as5\"><jats:title>Methods:<\/jats:title><jats:p>A multidisciplinary team from infectious diseases, allergy, anesthesiology, surgery, and pharmacy surveyed anesthesiology providers about their use of perioperative cephalosporins in penicillin-allergic patients. Using findings from that survey, the team designed a decision-support algorithm for safe utilization and provided 2 educational forums to introduce this algorithm, emphasizing the safety of cefazolin or cefuroxime in penicillin-allergic patients without history of a severe delayed hypersensitivity reaction.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2100310X_as6\"><jats:title>Results:<\/jats:title><jats:p>The percentage of penicillin-allergic patients receiving a perioperative cephalosporin improved from \u223c34% to &gt;80% following algorithm implementation and the associated educational interventions. This increase in cephalosporin use was associated with a \u223c50% reduction in antibiotic cost per penicillin-allergic patient. No significant adverse reactions were reported.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2100310X_as7\"><jats:title>Conclusions:<\/jats:title><jats:p>An educational antibiotic stewardship intervention produced a significant change in clinician behavior. A simple intervention can have a significant impact, although further study is needed regarding whether this response is sustained and whether an educational intervention is similarly effective in other healthcare systems.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2021.310","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T09:30:53Z","timestamp":1629106253000},"page":"1101-1107","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":14,"title":["Anatomy of a successful stewardship intervention: Improving perioperative prescribing in penicillin-allergic patients"],"prefix":"10.1017","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6845-5595","authenticated-orcid":false,"given":"Mary Elizabeth","family":"Sexton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merin Elizabeth","family":"Kuruvilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis A.","family":"Wolf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant C.","family":"Lynde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zanthia","family":"Wiley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"key":"S0899823X2100310X_ref8","doi-asserted-by":"crossref","first-page":"2732","DOI":"10.1093\/cid\/ciaa475","article-title":"W OB, Itani K, Gupta K, Branch-Elliman W. 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Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin","volume":"88","author":"Robertsson","year":"2017","journal-title":"Acta Orthop"},{"key":"S0899823X2100310X_ref15","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1093\/cid\/cix692","article-title":"Long-term impact of an educational antimicrobial stewardship program on hospital-acquired candidemia and multidrug-resistant bloodstream infections: a quasi-experimental study of interrupted time-series analysis","volume":"65","author":"Molina","year":"2017","journal-title":"Clin Infect Dis"},{"key":"S0899823X2100310X_ref6","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1016\/j.joms.2017.02.006","article-title":"Surgical site infections in patients receiving osteomyocutaneous free flaps to the head and neck. does choice of antibiotic prophylaxis matter?","volume":"75","author":"Murphy","year":"2017","journal-title":"J Oral Maxillofac 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