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Post by Kristen Horsman on Jul 11, 2019 14:55:54 GMT -5
The July journal club is presented by Jess Hadley. The article discusses the impact of penicillin allergies and hospital protocols affecting surgical site infection. This is an interesting read as we just recently changed our algorithm and antibiotic use for PCN allergies. You have one month to complete your response; you will be able to respond until August 12, due to the delay. Here is a link to the article. Questions to answer: 1. In practice, do you routinely question pcn allergic patients as to type of reaction, timing of reaction, etc. 2. Do the results of the studies cause you to rethink how you will administer antibiotics in the future?
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Post by Soo-Ok Kim on Jul 11, 2019 17:38:59 GMT -5
Thank you, Jessica, for great article for this month.
1. Yes, I routinely, not always, ask patient about the reaction to PCN or any other meds allergy. Most of the reactions as this article mentioned were no true allergic reaction. 2. I already changed my practice regarding antibiotic administration. I believe other practitioners have modified the practice already since this article was published in Feb. 2018. The timing as well as the kinds of antibiotic administration is important as described. Most beta lactam antibiotic can reach MIC pretty quickly, so giving those close to incision time, not too early, is also important.
Soo-Ok Kim
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Post by Jessica Hadley on Jul 16, 2019 7:24:38 GMT -5
1. I am making an effort to ask patients with a documented pcn allergy what the reaction is. I also ask if patients have ever had a cephalosporin before like Keflex. A lot of patients are unsure of the reaction or tell me it was a long time ago.
2. I routinely try to administer Ancef as a first line agent according to the recommendations in this article. However, I have had some resistance from surgeons and attendings who are not aware of this study. I think it's important to keep educating other staff, the more others hear these recommendations the more likely they will be to accept a change in practice.
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Post by jkim54 on Jul 16, 2019 8:05:42 GMT -5
1.Especially these days (as our ortho service has been more aggressive with using Ancef as their first line of prophylactic antibiotic), I have been asking more frequently what specific reaction a patient has to past penicillin exposure. I would say that the majority of the time their responses do not fall into the category of having a true contraindication to a beta-lactam antibiotic.
2.This article definitely highlights for me the importance of identifying what a true contraindication to a beta lactam antibiotic is, especially since those with a reported PCN allergy are 50% more likely to develop a SSI postoperatively. The article also highlights the importance of prophylactically treating the patient with the proper antibiotics in the optimal timeframe for tissue concentration to offset the likelihood of developing SSI.
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Post by kels on Jul 18, 2019 15:39:52 GMT -5
I do ask patients that are allergic to penicillin about the timing of the reaction, the symptoms that were experienced and the severity of the symptoms .
I agree that knowing what is considered a true contraindication to a beta lactam is important and making sure when giving any antibiotic the timing of administration is considered
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Post by LarSharVeA Bailey on Jul 19, 2019 9:53:15 GMT -5
I have recently began asking more detail about penicillin allergies. I am most often than not given nebulous responses.
While it is obvious that one would logically avoid a drug that a patient reports as a true allergy, it is important to assess the subjective data in it's entirety. I would not want to withhold ancef from a patient that reports diarrhea or pruritus and risk an SSI and it's associated sequelae.
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Post by Katya on Jul 22, 2019 9:27:01 GMT -5
1. I usually ask patients about PCN allergy, what kind of reaction they had, and if they had allergy testing. 2. I already changed my antibiotics practice, depends on patient answer I try to follow guidelines that we recently received. But I give them small dose and wait to see if they have any reaction before I give the rest of the dose.
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Post by Jocelyn Datud on Jul 22, 2019 12:30:21 GMT -5
1. After verifying patient's medication allergy, I ask for what kind of reaction did they get from the medication.
2. 50% increased odds of developing SSI is huge. I think being able to send patients, with high chances of having true allergy to PCN, to the skin test clinic will help minimize this.
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Post by Ben Waldbaum on Jul 22, 2019 15:04:13 GMT -5
1.) When this article was published, it immediately had an impact on my practice. besides asking patients detailed questions about any penicillin allergy, I have communicated the results of this study with many surgeons unaware of the results. I have even explained to patient's the increased risk of infection with a non-penicillin antibiotic. As a result, I'd estimate I'm giving cefazolin to at least 50% of patients who arrive with a "penicillin allergy"
2.) Absolutely. We have a duty to do everything we can do reduce SSI w/one example being the correct antibiotic. This warrants constant study as bacteria are constantly adapting.
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Kristen Praesel Lang
Guest
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Post by Kristen Praesel Lang on Jul 26, 2019 13:31:18 GMT -5
1. In practice, do you routinely question pcn allergic patients as to type of reaction, timing of reaction, etc.
Yes, I routinely ask patients about the specifics of their reaction to penicillin or other drugs. There are times when the drug reaction already appears to be thoroughly described in documentation.
2. Do the results of the studies cause you to rethink how you will administer antibiotics in the future?
I have always considered the timing of my antibiotic in regards to surgical incision time. I routinely give ancef as a first line antibiotic and initiate a discussion with the team (anesthesia / surgery) when a pcn allergy is listed, but likelihood of cross reactivity with a cephalosporin appears to be low.
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Post by Lu Lin on Jul 29, 2019 11:15:32 GMT -5
1. Yes, I routinely ask patient about the reaction to PCN or any other medication allergy. I also asked any anaphylaxis reaction to any medication. 2. I changed my practice regarding antibiotic administration. I believe other practitioners have modified the practice since this article was published in Feb. 2018. The timing as well as the kinds of antibiotic administration is important as described. Most beta lactam antibiotic can reach MIC pretty quickly, so giving those close to incision time, not too early, is also important.
Lu Lin
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nanci
Junior Member
Posts: 57
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Post by nanci on Jul 29, 2019 15:58:51 GMT -5
1) Yes ask patient about the PCN reactions.
2) Adapted this to practice because a plastic surgeon brought it to my attention. Tend to go back through the previous charts more often and seek antibiotic that was given and if there was a reaction noted. Often I have seen PCN allergy and they were given Ancef in the past without noted reaction- so always good to look and ask. Try to stay current and adapt to new concepts in anesthesia. Have seen our antibiotic prophylaxis chart change through the years to accommodate administration changes as well.
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July FY20
Jul 30, 2019 13:27:38 GMT -5
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Post by Shannon on Jul 30, 2019 13:27:38 GMT -5
1. I definitely inquire about penicillin allergies and the response as well as the timeliness of the response. I have been doing this for approximately 6 to 7 years after I had an encounter with a not so kind surgeon in regard to my dosing of clindamycin instead of and ancef. After that encounter I did my own research and realized that it really doesn't make that big of a deal most of the time. If the patient's response is hives or pruritus; we definitely would rather have those things than a surgical site infection. Kind of like Ben, when that is explained to the patient candidly they usually understand and agree to receive the ancef dosing. It would be really nice if we as CRNAs could know the patients that get surgical site infections that we have cared for. I think that would give us the biggest insight into this topic.
2. The article itself did not contribute to my change in practice, as I had already changed my practice. But definitely a very clinically applicable article.
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Post by Sarah Rollison on Jul 31, 2019 6:46:58 GMT -5
1. My practice is to absolutely inquire about the PCN reaction, including the specific physiologic reaction, timing of when it happened, and if they ever had a similar reaction to other antibiotics. Although our current practice suggests that there is a low chance of cross over with cephalosporins, I think it is important to ask if they have had this reaction to any other specific antibiotics.
2. I think this article helps me to understand the reasoning for current practice and why Ancef can be given to those who are labeled PCN allergic. Although I was already practicing this way, the article helped me better grasp the risk of surgical site infection and the risk of other complications such as C Diff. It is shocking to know that there is a 50% increase in the chances of a SSI because of antibiotic choice for the PCN allergic patients.
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Post by Moishe Mayer on Jul 31, 2019 7:57:35 GMT -5
1: I do question PCN allergy with a little more scrutiny than other drug allergies. This is probably because it is closely tied to our ability to administer ABX. Based on the current JHH guidelines, the only significant reactions are Anaphylaxis, hives, and stevens johnson like syndrome. This has helped me increase my administration of Ancef to PCN allergic pts.
2: This study highlights the importance giving Ancef over other ABX. It will play a big role in trying our best to administer Ancef whenever possible.
Great Study.
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