{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:44:50Z","timestamp":1785422690148,"version":"3.56.0"},"reference-count":22,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Studies have shown there is minimal risk of cephalosporin cross-reactivity with penicillin (PCN), though avoidance in practice still occurs. Avoidance of cephalosporins due to reported PCN allergies can result in negative clinical outcomes. Removal of cross-reactivity alerts from the electronic health record (EHR) may increase cephalosporin utilization. The objective of this study was to evaluate cephalosporin utilization in those with documented intermediate-, high-, and severe-risk allergies following an EHR cross-reactivity alert removal. This was a retrospective, observational, pre\u2013post review of patients with a documented intermediate-, high-, or severe-risk PCN allergy who received at least one dose of a systemic antibiotic for an indication in which a cephalosporin was first line. An EHR alert removal was implemented along with system-wide guideline updates and education. The primary outcome was the rate of cephalosporin utilization. Secondary outcomes included rates of PCN utilization, antibiotic adverse effects, and a composite of treatment failure. A total of 235 patients were included (pre = 118, post = 117). Intermediate-risk allergies made up a majority of the population (74%), with surgical site infection prophylaxis being the most common antibiotic indication (63%). Cephalosporin utilization significantly increased after alert removal (27% vs 67%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Use of cefazolin increased by 47% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), while use of alternative agents, clindamycin and vancomycin, decreased by 12.5% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.032) and 13.4% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.021), respectively. No patients had an allergic reaction to cephalosporins. Removal of a PCN\u2013cephalosporin cross-reactivity alert from the EHR increased cephalosporin utilization without adverse allergy-related sequelae in those with intermediate- and high-risk PCN allergies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/aac.01820-25","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T13:00:48Z","timestamp":1778850048000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Cephalosporin use and patient outcomes following removal of penicillin\u2013cephalosporin cross-reactivity alerts from the electronic health record"],"prefix":"10.1128","volume":"70","author":[{"given":"Alicia","family":"Zimmer","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00trqv719","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Pharmacy, University of Rochester Medical Center, Highland 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