Effect of penicillin allergy on prophylactic antibiotic administration in the parturient undergoing cesarean delivery.

BACKGROUND: Administering antibiotics is often difficult in patients with specific medication allergies. This investigation aimed to determine if a penicillin or cephalosporin allergy increased the risk for not receiving correct timing of prophylactic antibiotics at cesarean delivery. We hypothesized that patients with a penicillin or cephalosporin allergy would be less likely to receive antibiotics prior to incision for cesarean delivery. METHODS: All women undergoing cesarean delivery at Mayo Clinic Hospital, from 1 March 2008, to 28 February 2018 were retrospectively identified by electronic medical record query. Patients were grouped based on allergy status to penicillin/cephalosporins. Data recorded included the type and time of antibiotic given in relation to surgical incision. The primary outcome of this study was administration of antibiotics within 60 minutes prior to surgical incision. Characteristics potentially associated with the primary outcome were assessed using logistic regression. RESULTS: Of the 818 patients with a penicillin or cephalosporin allergy, 75 (9.2%) did not receive prophylactic antibiotic within 60 minutes prior to skin incision. Conversely, 326 (6.9%) of the 4744 patients without a penicillin or cephalosporin allergy did not receive their prophylactic antibiotic within 60 minutes prior to skin incision (P = .019). Patients undergoing an emergent cesarean delivery were also at an increased risk of not receiving their prophylactic antibiotic within 60 minutes prior to skin incision (P < .001). CONCLUSION: Patients with a penicillin or cephalosporin allergy were less likely to receive prophylactic antibiotics within the recommended 60 minutes prior to surgical incision. Clear plans and communication are important for ensuring proper antibiotic administration at cesarean delivery to prevent surgical site infection.

Disseminated intravascular coagulation after craniotomy.

Disseminated intravascular coagulation (DIC) is reported in neurosurgical patients; however, the incidence of DIC after craniotomy procedures is unknown. Using a surgical database, we identified 3164 patients who underwent primary craniotomy at Mayo Clinic Rochester between January 1, 2000 and December 31, 2004. Potential cases of DIC in this population were identified using 3 search triggers, patients: (1) in whom the diagnosis of DIC was noted on their hospital discharge summary, (2) who received red blood cell-free blood products, or (3) in whom a blood fibrinogen or d-dimer concentration was assessed. Using criteria based on laboratory values, we estimated the incidence of DIC developing within 72 hours of primary craniotomy to be between 13 and 44 per 10,000 patients. Despite a low incidence of DIC, the associated mortality rate was 43% to 75%. Traumatic head injury was a significant risk factor for the development of DIC [odds ratio of trauma was in the range of 16 (95% confidence interval (CI)=5.3-49) to 29 (CI=4.0-204)]. Autologous salvaged blood was administered intraoperatively to 44 patients, and 1 of these developed DIC. Although this small sample of patients receiving salvaged blood requires caution in interpreting the results, the risk of DIC seemed to be greater with salvaged blood than without [odds ratio 24 (CI=2.5-237)]. In children, 2 of 3 patients who developed DIC had congenital malformations of the brain. Findings from this study suggest that DIC is rare after craniotomy, but is often associated with mortality.