Cefazolin outperforms second-line antibiotics in surgery patients with beta-lactam allergy
Key takeaways:
- Cefazolin was associated with fewer surgical site infections among patients with a beta-lactam allergy who underwent joint arthroplasty.
- It was not associated with more interoperative hypersensitivity reactions.
Cefazolin reduced surgical site infections compared with second-line antibiotics among patients with a beta-lactam allergy who had total joint arthroplasty, with no increase in hypersensitivity reactions, researchers determined.
“Guideline-recommended first-line surgical site infection (SSI) prophylaxis for total joint arthroplasties is cefazolin, but patients with a beta-lactam allergy often receive second-line antibiotics,” Miranda R. Norvell, PharmD, a PGY2 internal medicine pharmacy resident at Barnes-Jewish Hospital in St. Louis, told Healio.
“Avoiding SSIs, especially periprosthetic join infections, is very important for this patient population as this is a devastating complication of total joint arthroplasties,” Norvell said.
Norvell and colleagues retrospectively reviewed the incidence of SSIs and interoperative hypersensitivity reactions (HSRs) among patients labeled as allergic to penicillin or cephalosporin antibiotics who underwent a primary total hip and/or knee arthroplasty at the hospital between Jan. 1, 2020, and July 31, 2021.
They reviewed patients charts to compare the frequency of SSI within 90 days of surgery and HSRs among patients who received cefazolin vs. those who received clindamycin and/or vancomycin, which are frequently prescribed to patients labeled allergic to beta-lactams.
Among 1,128 hip and/or knee arthroplasties included in the analysis, 809 involved cefazolin and 319 involved clindamycin and/or vancomycin. According to the study, of the 1,047 patients who underwent these procedures, more in the clindamycin and/or vancomycin group had a history of cephalosporin allergy and allergic reactions with immediate symptoms.
According to the review, there was a lower incidence of SSIs in the cefazolin group compared with the clindamycin and/or vancomycin group — 0.9% vs. 3.8% (RR = 4.3; 95% CI, 1.7-10.9) — including fewer prosthetic joints infections (0.1% vs. 1.9%). There were also fewer superficial incisional infections in the cefazolin group (0.7% vs. 1.9%), as well as fewer prosthetic joint infections (0.1% vs. 1.9).
Additionally, the study showed that the frequency of interoperative HSRs did not differ between the cefazolin and clindamycin/vancomycin groups (0.2% vs.1.3%; P = .06).
“Cefazolin should be used [as a first-line agent] for patient's undergoing a total joint arthroplasty regardless of penicillin or beta-lactam allergy history,” Norvell concluded.
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