Related Experiment Video
Updated: May 12, 2026
Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy
Published on: January 10, 2019
Lumbar Fusion Surgical Prophylaxis Using Cefazolin Versus Vancomycin in the Penicillin-Allergic Patient
Michael Carter1, Rajkishen Narayanan, Gregory Toci
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
Study Design:
Retrospective cohort study.
Objective:
To compare perioperative and postoperative infection rates among patients with mild to moderate penicillin allergies who receive cefazolin versus vancomycin as prophylaxis for lumbar fusion. In addition, we sought to determine if patients receiving cefazolin exhibited any clinical symptoms suggestive of drug-induced hypersensitivity reactions, and to compare those rates to patients who received vancomycin.
Summary Of Background Data:
Cefazolin has been historically linked to hypersensitivity reactions in penicillin-allergic patients due to cross-reactivity. As a result, vancomycin is often given to these patients instead. To our knowledge, no studies have directly compared these two antibiotics in penicillin-allergic patients undergoing lumbar fusion.
Materials And Methods:
Patients with mild to moderate documented penicillin allergies who underwent lumbar fusion from 2017 to 2022 and received prophylactic cefazolin or vancomycin were studied. Demographic, surgical information, and hospital length of stay (LOS) were recorded. We identified drug sensitivity reactions, in hospital infections, 90-day readmissions related to infectious etiologies and need for irrigation and debridement (I&D) to treat a surgical site infection.
Results:
Two hundred twenty-two patients received cefazolin, while 180 received vancomycin. Patients receiving vancomycin had more medical comorbidities, while patients receiving cefazolin had slightly more levels fused. No significant differences existed between cohorts in postoperative infection rate. One patient given cefazolin developed a mild drug-induced skin reaction that was treated with topical steroids. No significant differences existed between cohorts in 90-day readmissions or need for I&D surgery. On bivariate analysis, patients given cefazolin had a longer LOS but this was attributed to confounding variables on multivariate analysis.
Conclusions:
Cefazolin and vancomycin are comparable at preventing postoperative infections among patients with mild to moderate documented reactions to penicillin. Our findings also suggest that penicillin-allergic patients are not at higher risk of developing drug-related hypersensitivity reactions in response to cefazolin exposure when compared with those who received vancomycin.
Insights
For patients with mild penicillin allergies undergoing lumbar fusion, cefazolin and vancomycin are equally effective in preventing postoperative infections. Cefazolin does not increase the risk of hypersensitivity reactions compared to vancomycin.
Area of Science:
- Infectious Disease
- Neurosurgery
- Pharmacology
Background:
- Penicillin-allergic patients historically receive vancomycin for surgical prophylaxis due to concerns of cefazolin cross-reactivity.
- Limited direct comparative data exists for cefazolin versus vancomycin in penicillin-allergic patients undergoing lumbar fusion.
Purpose of the Study:
- Compare peri- and postoperative infection rates between cefazolin and vancomycin prophylaxis in mild to moderate penicillin-allergic patients undergoing lumbar fusion.
- Evaluate the incidence of drug-induced hypersensitivity reactions to cefazolin versus vancomycin in this patient population.
Main Methods:
- Retrospective cohort study of patients undergoing lumbar fusion from 2017-2022.
- Analysis of infection rates, drug sensitivity reactions, 90-day readmissions, and need for irrigation and debridement (I&D).
- Comparison of outcomes between patients receiving cefazolin versus vancomycin prophylaxis.
Main Results:
- No significant difference in postoperative infection rates between cefazolin and vancomycin groups.
- One mild drug-induced skin reaction observed in the cefazolin group; no significant difference in hypersensitivity reactions.
- Comparable rates of 90-day readmissions and I&D surgery between the two antibiotic groups.
Conclusions:
- Cefazolin and vancomycin demonstrate comparable efficacy in preventing postoperative infections for penicillin-allergic patients undergoing lumbar fusion.
- Penicillin-allergic patients with mild to moderate reactions are not at increased risk of hypersensitivity to cefazolin compared to vancomycin.
Related Concept Videos
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
01:23Inhibitors of Gram-positive Cell Wall Synthesis
01:25Clinical Significance of Antibiotic Resistance