Analysis of perioperative antibiotic usage in the operating room during the 2019 cefazolin shortage in Japan: a...

A stable supply of pharmaceuticals is essential for safe perioperative management. In 2019, Japan experienced a nationwide shortage of cefazolin (CEZ), a first-line prophylactic antibiotic, following the suspension of shipments by a major manufacturer (Company A). This study aimed to examine how this shortage influenced perioperative antibiotic selection in operating rooms across Japan.

We analyzed antibiotic usage data at 37 of 42 facilities that participated in the Japanese Epidemiologic Study for Perioperative Anaphylaxis (JESPA, UMIN000035350) from July 2019 to July 2020. The usage frequency of each antibiotic administered under general anesthesia was evaluated. Statistical analyses included the Mann-Whitney U test and multivariable linear regression, with CEZ usage proportion as the dependent variable.

During the CEZ shortage period (July to December 2019), CEZ usage decreased, whereas the use of alternatives such as cefmetazole, flomoxef, sulbactam/ampicillin, and clindamycin increased. Facilities supplied exclusively by Company A (Group A) showed a significantly greater decline in CEZ usage than those with other/multiple suppliers (Group B) (p < 0.001). Multivariable analysis identified manufacturer group as the only significant factor associated with CEZ usage (Group B vs. Group A: β = 2.11, 95% CI 1.52 to 2.71, p < 0.001; adjusted R² = 0.64).

The drop in CEZ supply reduced its perioperative use and increased reliance on alternative antimicrobials. The impact was less severe at facilities with multiple suppliers, suggesting supplier diversification may help mitigate future shortages. These findings, based on actual administration data from operating rooms across Japan, provide insights for ensuring a stable antibiotic supply.