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Updated: Jan 6, 2026
08:06
The Use of a β-lactamase-based Conductimetric Biosensor Assay to Detect Biomolecular Interactions
Published on: February 1, 2018
9.4K
Non-β-Lactam Antibiotic Use, β-Lactam Allergy, and Surgical Site Infections
Prateek Agarwal1, Rohit Prem Kumar1, Louise-Marie Oleksiuk2
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
JAMA Surgery
|October 1, 2025
Summary
Surgical site infections (SSIs) were higher with non-β-lactam antibiotics compared to β-lactams. Reported β-lactam allergy did not independently increase SSI risk, highlighting the need for accurate allergy assessment.
Area of Science:
- Infectious Disease Epidemiology
- Surgical Infection Prevention
- Antibiotic Stewardship
Background:
- Surgical site infections (SSIs) represent a significant global health and economic challenge.
- While β-lactam antibiotics are standard for surgical prophylaxis, their superiority over non-β-lactam agents is debated, particularly in patients with reported β-lactam allergies.
Purpose of the Study:
- To investigate the relationship between patient-reported β-lactam allergy status, antibiotic choice (β-lactam vs. non-β-lactam), and the incidence of SSIs.
- To analyze these associations across diverse surgical specialties.
Main Methods:
- Retrospective cohort study utilizing a prospectively recorded database from a quaternary health center.
- Inclusion of 49,279 procedures across 10 surgical specialties performed between January 2021 and February 2024.
- Analysis of antibiotic prophylaxis (β-lactam vs. non-β-lactam), reported β-lactam allergy, and 30- to 90-day SSI incidence, controlling for patient demographics and comorbidities.
Main Results:
- Procedures using non-β-lactam antibiotics exhibited a higher SSI incidence (2.2%) compared to those using β-lactams (1.3%; RR, 1.69).
- Patients with a reported β-lactam allergy also showed a higher SSI incidence (1.8% vs. 1.3%; RR, 1.38).
- After adjusting for covariates and β-lactam allergy, non-β-lactam use remained associated with increased SSI risk (OR, 1.33), while the association with β-lactam allergy became non-significant (OR, 1.21). Orthopedic surgery showed a significant association between non-β-lactam use and SSI (OR, 3.01).
Conclusions:
- β-lactam prophylaxis is associated with significantly lower SSI rates compared to non-β-lactam alternatives.
- A reported β-lactam allergy does not appear to be an independent predictor of SSI risk.
- Precise allergy assessment is crucial to avoid unnecessary use of alternative antibiotics and optimize surgical infection prevention strategies.
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