β-Lactam vs Non-β-Lactam Antimicrobial Prophylaxis and Surgical Site Infection

Area of Science:

• Infectious Diseases
• Clinical Medicine
• Surgical Care

Background:

• β-lactam antibiotics are standard for surgical antimicrobial prophylaxis (SAP).
• Non-β-lactam SAP is used as an alternative, primarily for patients with β-lactam allergies.
• The association between non-β-lactam SAP and surgical site infection (SSI) rates requires further clarification.

Purpose of the Study:

• To determine if non-β-lactam SAP is associated with an increased risk of SSI compared to β-lactam SAP.
• To evaluate the impact of different non-β-lactam antibiotics on SSI rates.

Main Methods:

• A large cohort study utilizing the Swissnoso SSI surveillance system (2009-2020).
• Included adult patients undergoing major surgery receiving SAP within 120 minutes pre-incision.
• Mixed-effects logistic regression models were used to analyze SSI occurrence, adjusting for confounding factors.

Main Results:

• Non-β-lactam SAP was administered to 1.7% of patients, while β-lactam SAP was given to 98.3%.
• Patients receiving non-β-lactam SAP had a significantly higher SSI rate (6.1%) compared to those on β-lactam SAP (2.8%).
• Non-β-lactam SAP was associated with a 1.78-fold increased odds of SSI, with higher risks observed for ciprofloxacin, vancomycin, and clindamycin.

Conclusions:

• Non-β-lactam surgical antimicrobial prophylaxis is associated with a significantly higher risk of surgical site infections.
• These findings suggest that non-β-lactam SAP should be avoided when feasible.
• Careful evaluation of patients with reported β-lactam allergies is crucial before administering alternative antibiotics.