Impact of silencing automated penicillin cross-reactivity alerts on perioperative antibiotic prescribing and surgical site infection rates

Sep 30, 2026

Uploaded by Jiven

Evaluated the effect of silencing penicillin cross-reactivity alerts on perioperative antibiotic prescribing and surgical site infection (SSI) outcomes across 6 hospitals using an interrupted time series design. The intervention produced minimal change in cefazolin prescribing among patients labeled as penicillin-allergic, reported as sensitivity-analysis evidence only (P = 0.03). Silencing showed no influence on SSI rates (P = 0.32).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Abstract

Introduction

Methods

Infection Control & Hospital Epidemiology (2025), 46, 1265–1267 doi:10.1017/ice.2025.10311 Concise Communication Impact of silencing automated penicillin cross-reactivity alerts on perioperative antibiotic prescribing and surgical site infection rates Michael J. Durkin MD, MPH1 , Joshua Nordman MD1 , Alice Bewley MS1, Andrew Atkinson PhD1, Jonas Marschall MD1,2,3, Helen Newland PharmD3 and Kimberly G. Blumenthal MD, MSc4 1Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA, 2University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA, 3BJC Healthcare, St. Louis, MO, USA and 4Division of Rheumatology Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Abstract We evaluated the impact of silencing penicillin cross-reactivity alerts on perioperative antibiotic prescribing and surgical site infections (SSIs) in 6 hospitals using an interrupted time series analysis. Silencing the alerts minimally increased cefazolin prescribing among penicillin allergy labeled patients (sensitivity analysis only; P = 0.03) and had no influence on SSIs (P = 0.32) . (Received 31 March 2025; accepted 28 August 2025; electronically published 29 September 2025) Introduction An estimated 32 million people have a reported penicillin allergy in the US; 95% of these can tolerate penicillins and other betalactams. Patients with listed penicillin allergies are more likely to receive alternative antibiotics which are associated with increased hospital costs, drug toxicities, and adverse outcomes 1—including a 50% increase in surgical site infections (SSIs) and increased rates of Clostridioides difficile (C. diff), MRSA, and VRE.2,3 When a patient has a penicillin allergy listed on their profile, most electronic medical records (EMRs) will alert surgeons who try to prescribe cefazolin that a penicillin allergy exists, and that a cephalosporin is contraindicated. This changes prescribing practices: one study found 92% of patients without penicillin allergy received cefazolin compared to 12% of those with a charted penicillin allergy.2 Silencing of these alerts has led to increased cephalosporin prescribing without increasing adverse reactions.4 The purpose of this manuscript was to evaluate the impact of silencing a penicillin allergy cross-reactivity alert on the choice of perioperative antibiotic prophylaxis and SSI. Methods A detailed description of silencing the penicillin cross-reactivity alert is in the supplement. For descriptive summaries, categorical variables were expressed as number (percentage) and median (interquartile range) for continuous variables. Differences in aggregated prescription proportions and surgical site infection rates before and after the intervention were investigated using a Corresponding author: Michael J. Durkin; [Email:](Email: mdurkin@wustl.edu)[ mdurkin@wustl.edu](Email: mdurkin@wustl.edu) [Cite this article:](Cite this article: Durkin MJ)[ Durkin MJ](Cite this article: Durkin MJ), [Nordman J](Nordman J), [BewleyA](BewleyA), [et al](et al). Impact of silencing automated penicillin cross-reactivity alerts on perioperative antibiotic prescribing and surgical site infection rates. Infect Control Hosp Epidemiol 2025. 46: 1265–1267, doi: 10.1017/ ice.2025.10311 chi-square test. As primary analysis, we performed Poisson mixed effects interrupted time series analyses to evaluate the association between silencing penicillin allergy cross-reactivity alerts anda) antibiotic prescribing and b) SSI rates with BJC Healthcare, a 14 acute care hospital network in the St. Louis MO region. Models included the number of procedures as the denominator (offset) and accounted for intra-hospital correlation with a random effect for each hospital. The penicillin-cephalosporin allergy crossreactivity alert was silenced in March 2021 for patients with nonserious penicillin labels within BJC Healthcare (“time 0”) . We collected

FAQs

What did the study evaluate after silencing penicillin cross-reactivity alerts?

The study assessed perioperative antibiotic prescribing and surgical site infection (SSI) rates after silencing the alerts in six hospitals.

How did silencing the alerts affect cefazolin prescribing in penicillin-allergy labeled patients?

Cefazolin prescribing increased minimally; the effect was observed only in a sensitivity analysis (P = 0.03).

Did silencing penicillin cross-reactivity alerts change surgical site infection rates?

No. SSI rates were not influenced by silencing the alerts (P = 0.32).

Sep 30, 2026

Uploaded by Jiven