{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:08:27Z","timestamp":1792523307066,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,12,25]],"date-time":"2022-12-25T00:00:00Z","timestamp":1671926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Emerging literature has detailed the safe use of cefazolin in patients with immunoglobulin E\u2013mediated penicillin allergy labeling (PAL) such as hives and anaphylaxis. The purpose of this article is to detail efforts led by an antimicrobial stewardship pharmacist working with an interdisciplinary team to optimize preoperative antimicrobials in patients with PAL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A pharmacist-led, interdisciplinary collaborative practice agreement (CPA) was activated in January 2020 to permit pharmacists to independently optimize preoperative antibiotics to the preferred cefazolin in patients with PAL if nonsevere or severe reactions had been reported. A patient registry was established covering the timeframe between January 8, 2020, and January 6, 2022. Reaction during surgery was assessed via 2-provider documentation, which included surgeon and anesthesiology staff documentation of any complications during the procedure related to a suspected allergic safety event. Utilization of cefazolin, clindamycin, and vancomycin for preoperative prophylaxis was monitored before and after implementation of the CPA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the stated timeframe, 10,182 procedures and\/or surgeries were completed on 1,572 (15.4%) patients with PAL and 659 (41.9%) patients previously reporting at least one reaction categorized as a severe reaction, which was hives for 71.2% of these patients. Of the 659 patients with PAL reporting a severe reaction, 356 received a preoperative cephalosporin (cefazolin, 98.8%; ceftriaxone, 1.2%) and tolerated it without a reported safety event, including 52 patients with PAL previously reporting anaphylaxis. An increase in preferred preoperative antimicrobial prophylaxis utilization was noted (cefazolin: 86% to 96.3%, P &amp;lt; 0.001; 2019 to 2021) with reductions noted in the use of nonpreferred preoperative antibiotics (clindamycin: 2.1% to 0.2%, P &amp;lt; 0.001; vancomycin: 3.2% to 0.4%, P &amp;lt; 0.001; 2019 to 2021).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A pharmacist-led, interdisciplinary CPA increased preferred preoperative antimicrobial use in patients with PAL reporting severe allergic reactions, including hives and anaphylaxis, without reported safety events.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ajhp\/zxac385","type":"journal-article","created":{"date-parts":[[2022,12,25]],"date-time":"2022-12-25T21:01:20Z","timestamp":1672002080000},"page":"532-536","source":"Crossref","is-referenced-by-count":14,"title":["Pharmacist adjustment of preoperative antibiotic orders to the preferred preoperative antibiotic cefazolin for patients with penicillin allergy labeling"],"prefix":"10.1093","volume":"80","author":[{"given":"Sarah","family":"Lessard","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Huiras","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ala","family":"Dababneh","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Mayo Clinic , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Palraj","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Mayo Clinic , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Thies","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nate","family":"Woolever","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kandi","family":"Holt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Schwan","sequence":"additional","affiliation":[{"name":"Infection Prevention & Control, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Poelma","sequence":"additional","affiliation":[{"name":"Department of Nursing, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Tempelis","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Sawyer","sequence":"additional","affiliation":[{"name":"Department of Surgery Specialties, Mayo Clinic Health System , La Crosse, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,12,25]]},"reference":[{"issue":"3","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2146\/ajhp120568","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Am J Health-Syst Pharm"},{"issue":"6","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1016\/j.surg.2022.01.020","article-title":"Adherence and outcomes of a surgical prophylaxis guideline promoting cephalosporin use among patients with penicillin allergy","volume":"172","author":"Bhathal","year":"2022","journal-title":"Surgery"},{"issue":"3","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.surg.2021.03.022","article-title":"Safety of administering cefazolin versus other antibiotics in penicillin-allergic patients for surgical prophylaxis at a major Canadian teaching hospital","volume":"170","author":"Grant","year":"2021","journal-title":"Surgery"},{"issue":"9","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1017\/ice.2021.310","article-title":"Anatomy of a successful stewardship intervention: improving perioperative prescribing in penicillin-allergic patients","volume":"43","author":"Sexton","year":"2022","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"7","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1097\/CORR.0000000000001739","article-title":"Antibiotic stewardship interventions improve choice of antibiotic prophylaxis in total joint arthroplasty in patients with reported penicillin allergies","volume":"479","author":"Jones","year":"2021","journal-title":"Clin Orthop Relat Res"},{"issue":"3","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.surg.2021.02.063","article-title":"Comparison of immediate hypersensitivity reactions to preoperative antibiotics in patients labeled as penicillin allergic","volume":"170","author":"Fosnot","year":"2021","journal-title":"Surgery"},{"issue":"4","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/j.jaip.2019.12.016","article-title":"A streamlined approach to optimize perioperative antibiotic prophylaxis in the setting of penicillin allergy labels","volume":"8","author":"Kuruvilla","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"3","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1213\/ANE.0000000000003419","article-title":"Misconceptions surrounding penicillin allergy: implications for anesthesiologists","volume":"127","author":"Vorobeichik","year":"2018","journal-title":"Anesth Analg"},{"issue":"4","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1542\/peds.2004-1276","article-title":"A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients","volume":"115","author":"Pichichero","year":"2005","journal-title":"Pediatrics"},{"issue":"2","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.jaci.2005.10.032","article-title":"Immediate allergic reactions to cephalosporins: evaluation of cross-reactivity with a panel of penicillins and cephalosporins","volume":"117","author":"Antunez","year":"2006","journal-title":"J Allergy Clin Immunol"},{"issue":"4","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"354.e11","DOI":"10.1016\/j.amjmed.2005.10.052","article-title":"Is there cross-reactivity between penicillins and cephalosporins?","volume":"119","author":"Apter","year":"2006","journal-title":"Am J Med"},{"issue":"7627","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1136\/bmj.39372.829676.47","article-title":"In patients allergic to penicillin, consider second and third generation cephalosporins for life threatening infections","volume":"335","author":"Pegler","year":"2007","journal-title":"BMJ"},{"key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"13S","DOI":"10.1016\/j.diagmicrobio.2006.12.004","article-title":"Use of selected cephalosporins in penicillin-allergic patients: a paradigm shift.","volume":"57","author":"Pichichero","year":"2007","journal-title":"Diag Microbiol Infect Dis"},{"issue":"7","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.amjmed.2007.12.005","article-title":"Management of patients with history of allergy to \u03b2-lactam antibiotics","volume":"121","author":"Yates","year":"2008","journal-title":"Am J Med"},{"issue":"4","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1331\/JAPhA.2008.07006","article-title":"Cephalosporin use in treatment of patients with penicillin allergies","volume":"48","author":"DePestel","year":"2008","journal-title":"J Am Pharm Assoc"},{"issue":"5","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.jaci.2010.06.052","article-title":"IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of penicillins, monobactams, and carbapenems","volume":"126","author":"Romano","year":"2010","journal-title":"J Allergy Clin Immunol"},{"issue":"3","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jaip.2013.01.006","article-title":"Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital","volume":"1","author":"Picard","year":"2013","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"4","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"e210021","DOI":"10.1001\/jamasurg.2021.0021","article-title":"Assessment of the frequency of dual allergy to penicillins and cefazolin: a systematic review and meta-analysis","volume":"156","author":"Sousa-Pinto","year":"2021","journal-title":"JAMA Surg"},{"issue":"6","key":"2023040806190019300_","first-page":"1889","article-title":"Tolerability of cefazolin and ceftibuten in patients with IgE-mediated aminopenicillin allergy","volume":"8","author":"Ramano","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"8","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"2722","DOI":"10.1016\/j.jaip.2019.05.038","article-title":"Cross-reactivity to cephalosporins and carbapenems in penicillin-allergic patients: two systematic reviews and meta-analyses","volume":"7","author":"Picard","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"6","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1080\/14787210.2019.1617132","article-title":"Self-reported \u03b2-lactam intolerance: not a class effect, dangerous to patients, and rarely allergy","volume":"17","author":"Vyles","year":"2019","journal-title":"Expert Rev Anti Infect Ther"},{"issue":"3","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1093\/cid\/cix794","article-title":"The impact of a reported penicillin allergy on surgical site infection risk","volume":"66","author":"Blumenthal","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"2","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth consensus guidelines for the management of postoperative nausea and vomiting","volume":"131","author":"Gan","year":"2020","journal-title":"Anesth Analg"},{"issue":"10","key":"2023040806190019300_","first-page":"1111","article-title":"Anaphylaxis: recognition and management","volume":"84","author":"Arnold","year":"2011","journal-title":"Am Fam Physician"},{"issue":"2","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/all.15032","article-title":"EAACI guidelines: anaphylaxis (2021 update)","volume":"77","author":"Muraro","year":"2022","journal-title":"Allergy"},{"issue":"4","key":"2023040806190019300_","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.anai.2010.08.002","article-title":"Drug allergy: an updated practice parameter","volume":"105","author":"Joint Task Force on Practice Parameters, American Academy of Allergy, Asthma, and Immunology, American College of Allergy, Asthma, and Immunology, Joint Council of Allergy, Asthma, and Immunology","year":"2010","journal-title":"Ann Allergy Asthma Immunol"}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxac385\/48614938\/zxac385.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/80\/8\/532\/49800415\/zxac385.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/80\/8\/532\/49800415\/zxac385.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,3]],"date-time":"2023-12-03T14:13:20Z","timestamp":1701612800000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/80\/8\/532\/6960715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,25]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,12,25]]},"published-print":{"date-parts":[[2023,4,8]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxac385","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,4,15]]},"published":{"date-parts":[[2022,12,25]]}}}