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Cefazolin may be safe for patients with penicillin allergy

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David G. Lewallen

ORLANDO — Treatment with cefazolin may be safe in patients who report a penicillin allergy, may reduce the rate of infection and provide cost-savings in patients undergoing total joint replacement, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.

Although cefazolin is the gold standard for prophylaxis in patients undergoing TJR, David G. Lewallen, MD, noted 10% to 15% of patients self-report a penicillin allergy, which may lead to a cross reaction when cephalosporins are used. However, despite the common report of penicillin allergies, Lewallen said it is rarely true, with 1% to 10% of patients being confirmed with a penicillin allergy.

“The report of this results in changes in antibiotics and a 50% increase in surgical site infection rates in some reported series and the risk of getting MRSA goes up when you use alternatives to cephalosporins and a 26% increase of [Clostridioides difficile],” Lewallen said in his presentation here.

A study published by Lewallen and colleagues showed among approximately 3,400 patients who underwent allergy screening prior to surgery, 97% were cleared for cephalosporin use and 85% of patients received cephalosporin at the time of surgery. Lewallen added patients who received a non-cephazolin prophylaxis had a 32% increased risk for periprosthetic infection.

“We test all patients, or we recommend that, with a question of allergy, we try to do that, and we use cephazolin whenever we can, when it is deemed safe,” Lewallen said. – by Casey Tingle

References:

Lewallen DG. Paper 116. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 11-14, 2019; Orlando.

Wyles CC, et al. Bone Joint J. 2019;doi;10.1302/0301-620X.101B6.BJJ-2018-1407.R1.

Disclosure: Lewallen reports he has stock in Acuitive Technologies and Ketai Medical Devices; is a paid consultant for Acuitive Technologies and Zimmer Biomet; and receives royalties from MAKO/Stryker and Zimmer Biomet.