Screening for Beta-Lactam Allergy in Joint Arthroplasty Patients to Improve Surgical Prophylaxis Practice

Deanna L. McDanel, Antoine E. Azar, Amy M. Dowden, Samantha Murray-Bainer, Nicolas O. Noiseux, Melissa Willenborg, Charles R. Clark, John J. Callaghan, Ambar Haleem

Research output: Contribution to journalArticlepeer-review


Background The reliability of patient-reported penicillin allergies has been disputed. A Drug Allergy Clinic (DAC) was established at our institution in combination with an electronic best practice alert (BPA) in the Orthopedic Clinic. Joint arthroplasty patients with a reported history of beta-lactam allergy (HOBA) were preoperatively referred via the BPA to the DAC. The purpose of this study was to determine the effectiveness of beta-lactam allergy screening in enabling the surgical team to optimize antimicrobial prophylaxis. Methods Between February 2013 and May 2015, 161 patients with a HOBA were referred to the DAC where they underwent penicillin skin testing (PST), a drug challenge to a beta-lactam antibiotic, and/or had no intervention depending on the history obtained. Results PST was performed on 140 of 161 (87%) patients. A negative PST was noted in 139 (99%) patients, indicating no penicillin allergy. Cefazolin was safe to use in 145 (90%) patients evaluated. Significantly more patients evaluated in the DAC vs those not seen got cefazolin in any surgical prophylaxis regimen (90% vs 77%) without any adverse perioperative reactions. Concurrently, the use of non-beta-lactam antibiotics was significantly less in the patients evaluated vs not evaluated (16% vs 27%). The overall use of cefazolin in orthopedic surgeries in patients with HOBA was >84% over the course of the study period. Conclusion Beta-lactam allergy screening using a BPA and a DAC promotes the use of standard surgical prophylaxis with cefazolin. Joint arthroplasty surgeons should consider implementing allergy screening programs to promote antimicrobial stewardship.

Original languageEnglish (US)
Pages (from-to)S101-S108
JournalJournal of Arthroplasty
Issue number9
StatePublished - Sep 2017


  • allergy
  • beta-lactam
  • cefazolin
  • prophylaxis
  • screening
  • surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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