Cefazolin in Joint Surgery Safe Despite Antibiotic Allergy

TOPLINE:

For patients with beta-lactam allergy undergoing orthopedic surgery, prioritizing cefazolin as the preferred antibiotic for the prevention of surgical site infections (SSIs) did not lead to any probable hypersensitivity reactions, even among patients with a history of severe beta-lactam allergies. 

METHODOLOGY:

• Past practice had called for avoiding the use of cefazolin in patients with beta-lactam allergy, but this approach left patients at greater risk for SSIs. Newer studies established that cefazolin could be a safe option for these patients after all.
• Researchers conducted a retrospective review to evaluate the safety of a quality improvement protocol that recommended adopting cefazolin for SSI prophylaxis in patients allergic to beta-lactams — excluding those with a documented allergy to cefazolin.
• The analysis included 521 patients (average age, 58 years; 67.56% women) with a documented penicillin or cephalosporin allergy who underwent an elective orthopedic surgery.
• All the patients received a weight-based cefazolin dose within 60 minutes of incision, which was repeated every 8 hours postoperatively until discharge or to a maximum of three doses.

TAKEAWAY:

• None of the patients met the criteria for probable intraoperative hypersensitivity reactions.
• Twenty-four patients experienced intraoperative hemodynamic instability within 5 minutes of receiving the drug, but 14 of these patients received subsequent doses and did not experience further hemodynamic changes. The other 10 patients did not receive additional doses.
• No patient required intraoperative epinephrine or diphenhydramine or was labeled as allergic to cefazolin.

IN PRACTICE:

“We recommend adopting cefazolin as the standard of care for SSI prophylaxis in orthopedic surgeries, regardless of beta-lactam allergy history or severity, while excluding only those who had a documented cefazolin-specific allergy,” the authors wrote.

SOURCE:

Zachary Clarke, MD, with the Anderson Orthopaedic Research Institute in Alexandria, Virginia, was the first author of the study, which was published online on May 22 in The Journal of Arthroplasty. 

LIMITATIONS:

The limitations of the study were retrospective study design and the simultaneous use of other medications that can cause hypotension, the researchers noted. Future studies could validate the findings and consider other types of surgery, they wrote.

DISCLOSURES:

The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.