Optimizing cefazolin use for surgical antibiotic prophylaxis in beta-lactam allergic patients: A multidisciplinary quality improvement project

Cefazolin is the preferred prophylactic antibiotic for many surgical procedures but is often unnecessarily avoided in patients with reported penicillin and/or cephalosporin allergies. This quality improvement project aimed to increase cefazolin use for preprocedural prophylaxis in these patients. Quasi-experimental quality improvement study Safety net healthcare system in the United States Patients with reported penicillin and/or cephalosporin allergies undergoing procedures requiring antibiotic prophylaxis and anesthesiology services from January 2022 to October 2023 Interventions included the development of allergy management algorithms, educational sessions, electronic medical record updates, and audit and feedback by pharmacists The primary outcomes were changes in proportions of procedures for which cefazolin, clindamycin, and vancomycin were used for preprocedural antibiotic prophylaxis. The secondary outcomes were changes in proportions of procedures in which appropriate dose and timing of preprocedural antibiotic prophylaxis were administered. Data from 3414 patients undergoing various procedures requiring antibiotic prophylaxis and anesthesiology services during the study period were analyzed. The use of cefazolin increased from 30% pre-intervention to 73% post-intervention (p < 0.001), while clindamycin use decreased from 51% to 13% (p < 0.001), and vancomycin use decreased from 5.8% to 3.9% (p = 0.012). Appropriate antibiotic dosing increased from 89% to 93% (p = 0.048), and appropriate timing of preprocedural antibiotics improved from 49% to 74% (p < 0.001). A multi-pronged intervention significantly increased cefazolin use in patients with reported penicillin and/or cephalosporin allergies, leading to optimized antibiotic prophylaxis and reduced use of less effective alternatives.