Allergies
From Evidence to Practice: A Behaviourally Informed Multidisciplinary Strategy to Increase Cefazolin Prophylaxis in Joint Arthroplasty Patients with Penicillin Allergy Labels
By Chong Hua Kang, Yvonne Peijun Zhou, YiBo Wang and 7 others.
Abstract
Background
Cefazolin is recommended for surgical prophylaxis in most patients with penicillin allergy labels (PALs) but concerns over beta-lactam cross-reactivity often limit use. We evaluated a behaviourally informed, multidisciplinary antimicrobial stewardship strategy on cefazolin utilisation among patients with PALs undergoing joint arthroplasty.
Methods
Behavioural change frameworks identified determinants influencing perioperative antibiotic prescribing, which guided multidisciplinary antimicrobial stewardship strategy implementation over two phases: (1) department-level advocacy within Orthopaedics and then (2) hospital-wide advocacy. We retrospectively evaluated the strategies among adults with PALs undergoing primary total knee or hip arthroplasty. The primary outcome was cefazolin utilisation over time. Secondary outcomes included perioperative hypersensitivity reactions, surgical site infections (SSIs), and prosthetic joint infections (PJIs).