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. 2023 Apr 24;10(6):ofad224.
doi: 10.1093/ofid/ofad224. eCollection 2023 Jun.

Cefazolin vs Second-line Antibiotics for Surgical Site Infection Prevention After Total Joint Arthroplasty Among Patients With a Beta-lactam Allergy

Miranda R Norvell  1 , Melissa Porter  2 , Madison H Ricco  2 , Ryan C Koonce  3 , Craig A Hogan  3 , Eric Basler  3 , Megan Wong  4 , Meghan N Jeffres  2   4
Affiliations

Cefazolin vs Second-line Antibiotics for Surgical Site Infection Prevention After Total Joint Arthroplasty Among Patients With a Beta-lactam Allergy

Miranda R Norvell et al. Open Forum Infect Dis. .

Abstract

Background: Cefazolin is a first-line agent for prevention of surgical site infections (SSIs) after total joint arthroplasty. Patients labeled allergic to beta-lactam antibiotics frequently receive clindamycin or vancomycin perioperatively due to the perceived risk of a hypersensitivity reaction after exposure to cefazolin.

Methods: This single-system retrospective review included patients labeled allergic to penicillin or cephalosporin antibiotics who underwent a primary total hip and/or knee arthroplasty between January 2020 and July 2021. A detailed chart review was performed to compare the frequency of SSI within 90 days of surgery and interoperative hypersensitivity reactions (HSRs) between patients receiving cefazolin and patients receiving clindamycin and/or vancomycin.

Results: A total of 1128 hip and/or knee arthroplasties from 1047 patients were included in the analysis (cefazolin n = 809, clindamycin/vancomycin n = 319). More patients in the clindamycin and/or vancomycin group had a history of cephalosporin allergy and allergic reactions with immediate symptoms. There were fewer SSIs in the cefazolin group compared with the clindamycin and/or vancomycin group (0.9% vs 3.8%; P < .001) including fewer prosthetic joint infections (0.1% vs 1.9%). The frequency of interoperative HSRs was not different between groups (cefazolin = 0.2% vs clindamycin/vancomycin = 1.3%; P = .06).

Conclusions: The use of cefazolin as a perioperative antibiotic for infection prophylaxis in total joint arthroplasty in patients labeled beta-lactam allergic is associated with decreased postoperative SSI without an increase in interoperative HSR.

Keywords: antibiotic prophylaxis; hip arthroplasty; interoperative hypersensitivity reaction; knee arthroplasty; prosthetic joint infection.

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Conflict of interest statement

Potential conflicts of interest. All authors: no reported conflicts.

Figures

Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/cefazolin-vs-second-line-antibiotics-for-surgical-site-infection-prevention-after-total-joint-arthroplasty-among-patients-with-a-beta-lactam-allergy
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