Background Cefazolin is a first-line agent for prevention of surgical site infections (SSIs) after total joint arthroplasty. Patients labeled as allergic to beta-lactam antibiotics frequently receive clindamycin or vancomycin perioperatively due to the perceived risk of a hypersensitivity reaction after exposure to cefazolin. Methods This single-system retrospective review included patients labeled as allergic to penicillin or cephalosporin antibiotics and underwent a primary total hip and/or knee arthroplasty between January 2020 and July 2021. A detailed chart review was performed to compare the frequency of SSI within 90 days of surgery and interoperative hypersensitivity reactions (HSRs) between patients receiving cefazolin and patients receiving clindamycin and/or vancomycin. Results A total of 1,128 hip and/or knee arthroplasties from 1,047 patients were included in the analysis (cefazolin n = 809, clindamycin/vancomycin n = 319). More patients in the clindamycin and/or vancomycin group had a history of cephalosporin allergy and allergic reactions with immediate symptoms. There were fewer SSIs in the cefazolin group compared to the clindamycin and/or vancomycin group (0.9% vs. 3.8%, p < .001) including fewer prosthetic joints infections (0.1% vs. 1.9%). Frequency of interoperative HSRs were not different between groups, (cefazolin = 0.2% vs. clindamycin/vancomycin = 1.3%, p = .06). Conclusions The use of cefazolin as a perioperative antibiotic for infection prophylaxis in total joint arthroplasty in patients labeled beta-lactam allergic is associated with decreased postoperative SSI without an increase in interoperative HSR.
Background Prosthetic joint infection (PJI) is a devastating complication following knee and hip arthroplasty. Perioperative antibiotics are routinely used in an effort to decrease the risk of surgical site infections (SSI), including superficial skin infections and deep PJI. The American Academy of Orthopedic Surgeons recommend cefazolin as standard of care for SSI prophylaxis. However, non-beta-lactams are often used in patients labeled as allergic to penicillins or cephalosporins due to concern of increased hypersensitivity reactions (HSR). Methods This study examined the frequency of SSI and HSR after receipt of perioperative cefazolin compared to clindamycin and/or vancomycin (C/V) within adult patients labeled as allergic to penicillins or cephalosporins. Patients were included if they underwent primary total hip or knee replacement surgery between January 2020 and July 2021 within the University of Colorado Health system. The outcome of SSI was assessed up to 90 days after surgery. The outcome of HSR was assessed up to 60 minutes after the conclusion of surgery. Results The cohort included 1,128 patients (cefazolin, n=809; C/V, n=319). Baseline characteristics were similar between groups except the proportion of patients with a history of immediate allergy symptoms was greater in the C/V group (59.6%) compared to the cefazolin group (35.8%). The frequency of SSI was lower in the cefazolin group compared to the C/V group (0.9% vs. 3.8%, p < .01). The cefazolin group included 7 SSI, consisting of 6 superficial SSI and 1 deep PJI. The C/V group included 12 SSI, consisting of 6 superficial SSI and 6 deep PJI. HSR were not significantly different between patients receiving cefazolin vs. C/V (0.2% vs. 1.3%, p=.06). HSR in the cefazolin group consisted of skin involvement (n=1) and self-reported allergy in post-operative window (n=1). Both patients had a non-descript history of penicillin allergy. HSR in the C/V group consisted of skin involvement (n=2) and hemodynamic instability (n=2). Three of the four patients had a history of immediate cephalosporin allergy. Conclusion Among penicillin or cephalosporin allergic patients, the use of cefazolin was associated with a lower frequency of PJI without an increase in HSR during surgery. Disclosures All Authors: No reported disclosures.
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