Antimicrobial Stewardship in Patients with Penicillin Allergy Undergoing Hysterectomy for Benign Indications

Objective: This research was conducted to evaluate the incidence and predictors of appropriate antibiotic prophylaxis prior to hysterectomy performed for benign indications in patients with penicillin allergy.Materials and Methods: This was a retrospective cohort study of patients with self-reported penicillin allergy undergoing hysterectomy for benign indications at an academic medical center in 2018. The primary outcome was appropriate preoperative antibiotic administration based on the American College of Obstetricians and Gynecologists guidelines. Secondary outcomes included predictors of receiving appropriate antibiotic prophylaxis and incidence of preoperative allergy testing. Standard analysis for descriptive data was performed, and a multivariable logistic regression was fit to explore predictors for receiving appropriate preoperative antibiotics.Results: For this research, 230 patients met the inclusion criteria. Appropriate antibiotics were administered to 42.6% (n = 98) of patients. There were no significant differences in demographic factors between the groups. Preoperative allergy testing was performed in 3.9% of patients (n = 9). On multivariable logistic regression, the odds of receiving appropriate antibiotics were 0.16 times lower among methicillin-resistant Staphylococcus aureus carriers (confidence interval [CI]: 0.03, 0.91; p = 0.04), 2.50 times higher among those with 3 or more antibiotic allergies (CI: 1.15, 5.42; p = 0.02), 1.97 times higher among those with at least 1 comorbidity (CI: 1.06, 3.67; p = 0.03), 8.94 times higher if anaphylaxis was the reported allergy (CI: 3.53, 22.63; p < 0.001), and 6.24 times higher if the reported allergy was hives (CI: 3.17, 12.29; p < 0.001).Conclusions: More than half of patients with penicillin allergy undergoing hysterectomy received inappropriate prophylactic antibiotics. Patients with more medical comorbidities, greater number of antibiotic allergies, and immunoglobulin E-mediated hypersensitivity reactions to penicillin had higher odds of receiving appropriate prophylaxis. (J GYNECOL SURG 20XX:000)