P-387. Exploring the Association Between Penicillin Allergy Labels (PAL), β-Lactam Utilization and Surgical Site Infections

Abstract Background Several studies have reported higher surgical site infection (SSI) risk in patients with a penicillin allergy label (PAL). We explore the association between PAL, receipt of β Lactam Antibiotics and SSI in patients undergoing hip and knee arthroplasty.Figure 1: SSI per 100 Hip and Knee Arthroplasty Patients with and without a Penicillin Allergy Label (PAL) Stratified by Receipt of Preoperative β-Lactam Antibiotic Methods We performed a retrospective cohort study of hip (HPRO) and knee arthroplasty (KPRO) patients who underwent procedures in a large health system between August 1, 2022 and December 31, 2023 after implementation of a penicillin allergy risk assessment tool in the electronic health record. We compared demographic, clinical, procedural and SSI outcome data in patients with and without a PAL. Univariate and multivariable logistic regression were performed to assess for factors associated with risk of SSI.Table 1:Demographic and Clinical Characteristics of Hip and Knee Arthroplasty Patients with and without a Penicillin Allergy Label Results Of 9,802 patients who underwent 11,019 HPRO and KPRO procedures, 1851 (19%) reported a penicillin allergy and 102 (1.0%) had one or more SSI. PAL was more common in patients who were older, white, female, lived in areas with socioeconomic status Social Vulnerability Index (SVI) < 75th percentile and who had a higher American Society of Anesthesiologists (ASA) risk score. PAL patients were less likely to receive nasal iodine in the preoperative area. (Table 1) 77% of PAL patients received a preoperative β-lactam for prophylaxis with no reported adverse events. Patients with a PAL were 1.6 times more likely to have a SSI than those without a PAL. The trend toward higher risk of SSI in patients with PAL persisted regardless of whether the patient received preoperative β-lactam antibiotics (Figure 1). In the univariate analysis, day of surgery nasal iodine in the preoperative area and undergoing an outpatient procedure were protective whereas having a HPRO, revision, longer procedure, and higher ASA score were associated with higher odds of SSI. After adjustment for patient age, procedure type, revision, procedure duration, ASA score, outpatient procedure, receipt of a preoperative β-lactam antibiotic and receipt of nasal iodine in the preoperative area, PAL remained associated with 1.6 times higher odds of SSI (p=0.05).Table 2:Comparative Analysis of Unadjusted and Adjusted Odds Ratios for Hip and Knee Arthroplasty Surgical Site Infection Conclusion The increased risk of SSI in patients with PAL may not be fully explained by the lack of preoperative β-lactam antibiotic. More study is needed to assess further. Disclosures All Authors: No reported disclosures