Standardizing Safe Cefazolin Use in Total Joint Arthroplasty: A Multidisciplinary Triage Protocol.

Area of Science:

• Infectious Disease
• Allergy and Immunology
• Orthopedic Surgery

Background:

• Cefazolin is a first-line antibiotic for total joint arthroplasty (TJA), effectively preventing periprosthetic joint infection (PJI).
• A significant percentage of patients report penicillin allergy, but true IgE-mediated allergy is rare.
• Current practices often involve unnecessary allergy testing or avoidance of cefazolin in patients with reported beta-lactam allergies.

Purpose of the Study:

• To evaluate a novel algorithmic triage protocol for managing TJA patients with reported penicillin or cephalosporin allergies.
• To determine the safety and efficacy of administering cefazolin in this patient population.
• To reduce healthcare utilization associated with preoperative allergy evaluations.

Main Methods:

• Implementation of a multidisciplinary algorithmic triage protocol in January 2025 for TJA patients with reported beta-lactam allergies.
• Patients with a history of cefazolin allergy, anaphylaxis, angioedema to cephalosporins, or severe cutaneous adverse reactions (SCARs) were referred for allergy testing.
• Patients with IgE-mediated reactions to penicillin or non-anaphylactic reactions to non-cefazolin cephalosporins were safely administered cefazolin without further testing.

Main Results:

• In 2024, 62 patients underwent allergy testing, with only six advised to avoid cefazolin.
• Since protocol implementation in January 2025, no patients have been referred for beta-lactam allergy testing.
• Zero perioperative hypersensitivity reactions have been reported post-protocol implementation.

Conclusions:

• A standardized, multidisciplinary approach enables safe cefazolin administration in TJA patients with reported allergies.
• The protocol optimizes patient outcomes and reduces unnecessary healthcare utilization.
• This strategy improves perioperative care for patients with a history of penicillin or cephalosporin allergy.