National expert consensus on the management of antibiotic prophylaxis in surgical patients with a penicillin allergy label based on the Delphi method

Aurélie Gouel-Chéron^{1

2

3}, Catherine Neukirch^{4

5}, Annick Barbaud⁶, Axelle Dupont^{7

8

9}, Jean-Ralph Zahar¹⁰, Solen Kernéis^{8

11}, Marc Garnier^{12

13}, Gabriel Birgand^{14

15}, Sara Romano-Bertrand^{16

17}, Philippe Lesprit¹⁸, Sylvain Diamantis^{19

20}, Remy Gauzit²¹, Estelle Marcault⁷, Marc Leone²², Matthieu Boisson^{23

24}, Claire Roger²⁵, Claire Dahyot-Fizelier^{23

24}, Pascal Demoly²⁶, Anca Chiriac²⁶, Philippe Montravers^{1

2}

Affiliations

¹ Paris Cité University, Paris, France.
² Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP, Paris, France.
³ INSERM UMR1222, Antibodies in Therapy and Pathology, Institut Pasteur, Université de Paris Cité, Paris 75015, France.
⁴ Service de Pneumologie A, APHP Hôpital Bichat, Paris, France.
⁵ INSERM 1152, Université Paris Cité, Paris, France.
⁶ Department of Dermatology and Allergology, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, AP-HP Sorbonne Universite, Tenon Hopital, Paris, France.
⁷ Clinical Research, Biostatistics and Epidemiology Department, AP-HP Nord, Paris, France.
⁸ INSERM, IAME, Université Paris Cité, Paris F-75018, France.
⁹ INSERM CIC-EC 1425, Hôpital Bichat Claude Bernard, Paris, France.
¹⁰ IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
¹¹ Équipe de Prévention du Risque Infectieux (EPRI), AP-HP, Hôpital Bichat, Paris F-75018, France.
¹² Département d'anesthésie-réanimation et médecine périopératoire, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
¹³ iGReD, INSERM, CNRS, Université Clermont-Auvergne, équipe 10 « approche translationnel des lésions épithéliales et de leur réparation », Clermont-Ferrand, France.
¹⁴ Regional Center for Infection Prevention and Control Pays de la Loire, Centre Hospitalier Universitaire de Nantes, Nantes, France.
¹⁵ Cibles et Medicaments des Infections et de l'Immunite, IICiMed, Nantes Universite, Nantes, France.
¹⁶ Hospital Hygiene and Infection Control Team, University Hospital of Montpellier, Montpellier 34093, France.
¹⁷ Research Team 'Hydric Pathogens, Health and Environments', HydroSciences Montpellier, IRD, CNRS, University of Montpellier, Montpellier, France.
¹⁸ Service des Maladies Infectieuses et Tropicales, CHU Grenoble Alpes, Grenoble, France.
¹⁹ Service des Maladies Infectieuses et Tropicales, GHSIF, Melun, France.
²⁰ EA 7380 Dynamic, Université Paris Est Créteil, EnvA, USC ANSES, Créteil 94010, France.
²¹ Infectiologie Transversale, CHU Cochin, AP-HP, Paris 75014, France.
²² Department of Anaesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille Université, Marseille, France.
²³ UFR de Médicine et Pharmacie, INSERM U1070, PHAR2, Université de Poitiers, Poitiers, France.
²⁴ Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
²⁵ UR-UM103 IMAGINE, Univ Montpellier, Division of Anaesthesia and Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
²⁶ Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, IDESP, University of Montpellier, Montpellier, France.

PMID: 40046066
PMCID: PMC11880800
DOI: 10.1093/jacamr/dlaf024

National expert consensus on the management of antibiotic prophylaxis in surgical patients with a penicillin allergy label based on the Delphi method

Aurélie Gouel-Chéron et al. JAC Antimicrob Resist. 2025.

. 2025 Mar 5;7(2):dlaf024.

doi: 10.1093/jacamr/dlaf024. eCollection 2025 Apr.

Authors

Affiliations

¹ Paris Cité University, Paris, France.
² Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP, Paris, France.
³ INSERM UMR1222, Antibodies in Therapy and Pathology, Institut Pasteur, Université de Paris Cité, Paris 75015, France.
⁴ Service de Pneumologie A, APHP Hôpital Bichat, Paris, France.
⁵ INSERM 1152, Université Paris Cité, Paris, France.
⁶ Department of Dermatology and Allergology, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, AP-HP Sorbonne Universite, Tenon Hopital, Paris, France.
⁷ Clinical Research, Biostatistics and Epidemiology Department, AP-HP Nord, Paris, France.
⁸ INSERM, IAME, Université Paris Cité, Paris F-75018, France.
⁹ INSERM CIC-EC 1425, Hôpital Bichat Claude Bernard, Paris, France.
¹⁰ IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
¹¹ Équipe de Prévention du Risque Infectieux (EPRI), AP-HP, Hôpital Bichat, Paris F-75018, France.
¹² Département d'anesthésie-réanimation et médecine périopératoire, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
¹³ iGReD, INSERM, CNRS, Université Clermont-Auvergne, équipe 10 « approche translationnel des lésions épithéliales et de leur réparation », Clermont-Ferrand, France.
¹⁴ Regional Center for Infection Prevention and Control Pays de la Loire, Centre Hospitalier Universitaire de Nantes, Nantes, France.
¹⁵ Cibles et Medicaments des Infections et de l'Immunite, IICiMed, Nantes Universite, Nantes, France.
¹⁶ Hospital Hygiene and Infection Control Team, University Hospital of Montpellier, Montpellier 34093, France.
¹⁷ Research Team 'Hydric Pathogens, Health and Environments', HydroSciences Montpellier, IRD, CNRS, University of Montpellier, Montpellier, France.
¹⁸ Service des Maladies Infectieuses et Tropicales, CHU Grenoble Alpes, Grenoble, France.
¹⁹ Service des Maladies Infectieuses et Tropicales, GHSIF, Melun, France.
²⁰ EA 7380 Dynamic, Université Paris Est Créteil, EnvA, USC ANSES, Créteil 94010, France.
²¹ Infectiologie Transversale, CHU Cochin, AP-HP, Paris 75014, France.
²² Department of Anaesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille Université, Marseille, France.
²³ UFR de Médicine et Pharmacie, INSERM U1070, PHAR2, Université de Poitiers, Poitiers, France.
²⁴ Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
²⁵ UR-UM103 IMAGINE, Univ Montpellier, Division of Anaesthesia and Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
²⁶ Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, IDESP, University of Montpellier, Montpellier, France.

PMID: 40046066
PMCID: PMC11880800
DOI: 10.1093/jacamr/dlaf024

Abstract

Background: Patients with a penicillin allergy label have an increased risk of surgical site infection. Although a decision tree was published in 2019 to define which patients could benefit from direct cephalosporin use in the perioperative setting, this strategy remains unvalidated. This consensus statement aimed to adapt it based on an expert consensus to cover persisting caveats and to adapt it to an environment with poor allergist resources.

Methods: Perioperative antibiotic prophylaxis and allergy experts were invited to participate. The Delphi method was implemented using an online-secured network. The panellists were given 3 weeks to answer each round. A consensus was reached if more than 75% of the experts rated the item ≥ 7 and if less than 25% rated the item ≤ 3.

Results: Sixteen experts participated. A high level of agreement was obtained after four rounds, defining four categories of the index reaction: unknown, not compatible, or compatible with an immediate or delayed hypersensitivity reaction. Twelve items were defined to stratify the risk of true penicillin allergy according to the index reaction history. The experts agreed that patients with high-risk reactions could benefit from either an allergy work-up or beta-lactam alternatives use. Those at low risk could benefit from direct cephalosporin administration.

Conclusions: This resulted in an adapted decision tree to promote cephalosporin prescription in patients with penicillin allergy labels. It will be used in a stepped-wedge prospective multicentric randomized study to assess its applicability and acceptability to promote first- and second-generation cephalosporin administration in the perioperative period.

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Figures

**Figure 1.**
Chemical structures of (a) penicillin and (b) cephalosporin. The R1 side chain is indicated in plain circle, and R2 in dotted circle.

**Figure 2.**
Final decision tree for promoting cephalosporin administration among patients with a penicillin allergy label.

See this image and copyright information in PMC

References

1. Berríos-Torres SI, Umscheid CA, Bratzler DW et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017; 152: 784–91. 10.1001/jamasurg.2017.0904 - DOI - PubMed
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National expert consensus on the management of antibiotic prophylaxis in surgical patients with a penicillin allergy label based on the Delphi method

Affiliations

National expert consensus on the management of antibiotic prophylaxis in surgical patients with a penicillin allergy label based on the Delphi method

Authors

Affiliations

Abstract

Figures

References

LinkOut - more resources

Full Text Sources