Digital five-step questionnaire to enhance standard perioperative prophylaxis in surgical patients with reported allergy to beta-lactam-antibiotics.

Background: Most self-reported beta-lactam antibiotic (BLA) allergies are inaccurate. This study evaluated a digital tool designed to reassess beta-lactam allergies and enable the use of standard perioperative antibiotic prophylaxis (PAP) without the need for prior allergy testing. Methods: In this retrospective, observational single-center cohort study, a digital five-step questionnaire was utilized during preoperative anesthesia evaluations for surgical patients reporting beta-lactam allergies. The algorithm assessed the likelihood of a beta-lactam allergy and provided recommendations for either standard PAP or the use of an alternative agent. Adherence to the algorithm's recommendations and the incidence of allergic reactions following PAP were analyzed. Results: Between September 2020 and October 2022, 983 surgical patients reported beta-lactam allergies. Of these, 322 patients (33%) either did not receive anesthesia or did not require PAP. Among the remaining 661 patients, the algorithm recommended standard prophylaxis for 420 (64%). Of these, 262 patients received BLA, resulting in 2 allergic reactions (0.8%; negative predictive value: 99.2%), while 158 received alternative antibiotics contrary to the recommendation, leading to 3 allergic reactions (1.9%). For the 241 patients (36%) in whom the algorithm indicated a high probability of beta-lactam allergy, 197 (82%) received alternative antibiotics with 4 allergic reactions (2%). Forty-four patients (18%) received BLA contrary to the algorithm's recommendation, with no allergic reactions observed. Conclusions: The digital five-step algorithm was a simple and effective tool during preoperative assessment, enabling safe administration of standard PAP in 64% of surgical patients with reported beta-lactam allergies.