Characterization of Beta-Lactam Allergy and Outcomes Associated With Perioperative Antibiotic Choice in Renal Transplant Recipients.

PURPOSE: Beta-lactam allergies (BLAs) are commonly reported and may include true allergy or adverse effects. BLAs can lead to the use of suboptimal antimicrobials, resulting in adverse outcomes. At our institution, cefazolin is the preferred surgical prophylaxis for renal transplant (RT), with clindamycin used for BLAs. There is limited data available examining outcomes with the use of non-standard surgical site prophylaxis in RT.

METHODS

This study evaluated 1523 adult RT patients from December 1, 2019 to December 1, 2024, with 257 (16.9%) having a documented BLA. BLA reactions were classified as immediate/allergic and non-allergic. Secondary outcomes included surgical site infections (SSIs) within 30 days and Clostridium difficile within 60 days, and were compared between groups that received cefazolin and clindamycin.

RESULTS

A total of 13.0% of the population had true allergic-type reaction. The most common BLA was to penicillins (71.2%), then cephalosporins (46%) or multiple classes (10.8%). Allergic-type reactions were reported by 186 (72.4%), and non-allergic reactions were reported by 35 (13.6%), with 12 patients reporting both types, and 24 without recorded reactions. The most common immediate/allergic reaction was hives/rash (155 patients). The most common non-allergic reaction was gastrointestinal symptoms. For perioperative prophylaxis, 182 patients received clindamycin and 67 received cefazolin. There was no difference in C. difficile in the first 60 days. There was a higher rate of SSI in the first 30 days in patients who received clindamycin (29/182, 15.9%) compared to cefazolin (2/67, 2.99%), p = 0.006.

CONCLUSION

BLA is commonly reported, but the type of reactions should be critically evaluated, as non-standard antibiotics may increase SSI risk.