Related Experiment Video
Updated: Dec 30, 2025
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Self-reported beta-lactam allergy and the risk of surgical site infection: A retrospective cohort study
Philip W Lam1,2, Payam Tarighi3, Marion Elligsen4
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Objective:
To assess whether a self-reported β-lactam allergy is associated with an increased risk of surgical site infection (SSI) across a broad range of procedures and to determine whether this association is mediated by the receipt of an alternate antibiotic to cefazolin.
Design:
Retrospective cohort study.
Participants:
Surgical procedures sampled by an institutional National Surgical Quality Improvement Program database over an 18-month period (January 2017 to June 2018) from 7 surgical specialties.
Setting:
Tertiary-care academic hospital.
Results:
Of the 3,589 surgical procedures included in the study, 369 (10.3%) were performed in patients with a reported β-lactam allergy. Those with a reported β-lactam allergy were significantly less likely to receive cefazolin (38.8% vs 95.5%) or metronidazole (20.3% vs 26.1%) and were more likely to receive clindamycin (52.0% vs 0.2%), gentamicin (3.5% vs 0%), or vancomycin (2.2% vs 0.1%) than those without allergy. An SSI occurred in 154 of 3,220 procedures (4.8%) in patients without reported allergy and 27 of 369 (7.3%) with reported allergy. In the multivariable regression model, a reported β-lactam allergy was associated with a statistically significant increase in SSI risk (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.04-2.51; P = .03). This effect was completely mediated by receipt of an alternate antibiotic to cefazolin (indirect effect aOR, 1.68; 95% CI, 1.17-2.34; P = .005).
Conclusions:
Self-reported β-lactam allergy was associated with an increased SSI risk mediated through receipt of alternate antibiotic prophylaxis. Safely increasing use of cefazolin prophylaxis in patients with reported β-lactam allergy can potentially lower the risk of SSIs.
Insights
Patients with a reported beta-lactam allergy face a higher risk of surgical site infections (SSIs). This increased risk is linked to receiving alternative antibiotics instead of cefazolin, highlighting a potential area for improved patient safety.
Area of Science:
- Infectious Diseases
- Surgical Outcomes
- Clinical Pharmacy
Background:
- Self-reported beta-lactam allergies are common in surgical patients.
- The impact of these reported allergies on surgical site infection (SSI) risk is not fully understood.
- Current antibiotic prophylaxis guidelines may not adequately address patients with beta-lactam allergies.
Purpose of the Study:
- To determine if a self-reported beta-lactam allergy increases the risk of surgical site infections (SSIs).
- To investigate whether the use of alternative antibiotics, specifically those other than cefazolin, mediates this association.
- To evaluate the potential for optimizing antibiotic prophylaxis in patients with reported beta-lactam allergies.
Main Methods:
- A retrospective cohort study was conducted using data from the National Surgical Quality Improvement Program database.
- Surgical procedures across 7 specialties at a tertiary-care academic hospital were analyzed over an 18-month period.
- Multivariable regression models were used to assess the association between reported beta-lactam allergy, antibiotic choice, and SSI occurrence.
Main Results:
- Patients with a reported beta-lactam allergy were significantly less likely to receive cefazolin and more likely to receive alternative antibiotics like clindamycin, gentamicin, or vancomycin.
- The incidence of SSIs was higher in patients with a reported beta-lactam allergy (7.3%) compared to those without (4.8%).
- A reported beta-lactam allergy was independently associated with a statistically significant increase in SSI risk (aOR, 1.61; P = .03), an effect fully mediated by the use of alternative antibiotics.
Conclusions:
- Self-reported beta-lactam allergy is associated with an elevated risk of surgical site infections.
- This increased risk is primarily mediated by the administration of alternative antibiotic prophylaxis instead of cefazolin.
- Optimizing the use of cefazolin in patients with reported beta-lactam allergies could potentially reduce SSI rates.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...