First Place Award: Can cefazolin be used in orthopaedic surgery for patients with a self-reported non-IgE mediated penicillin allergy? A prospective case series
Bibliographic record
Abstract
Background: Cefazolin is the current recommendation for antibiotic prophylaxis in orthopaedic surgery. However, reported cross-reactivity to first generation cephalosporins in patients with a penicillin allergy ranges from 4% to 18%. In their reports on the rates of cross-reactivity, previous authors have not distinguished IgE from non-IgE reactions. The purpose of this study was to determine the various reactions that are reported as a penicillin allergy and the rate of cefazolin cross-reactivity in patients having only non-IgE reactions to penicillin. Methods: This is a prospective case study of consecutive patients undergoing orthopaedic surgery that had indications for prophylactic antibiotics over a 4-year period. The patients’ self-reported specific allergic reactions to penicillin were noted. The reactions were characterized as either IgE or non-IgE mediated. Non-IgE mediated penicillin allergic patients were given cefazolin in the operating room under a controlled setting. Any adverse reaction after the administration of cefazolin was recorded. Results: There were 801 patients. The prevalence of a reported penicillin allergy was 14.1%. Non-IgE mediated reactions accounted for 73.5% of patients reporting a penicillin allergy. Of the 81 non-IgE mediated penicillin allergic patients who received cefazolin, no adverse reactions were reported. Conclusions: It is important to obtain the specific reaction in patients reporting that they are allergic to penicillin to guide the choice of antibiotics. In patients who report a non-IgE reaction to penicillin, it is safe to administer cefazolin.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.012 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".