ArticleJAMA network open2025
β-Lactam vs Non-β-Lactam Antimicrobial Prophylaxis and Surgical Site Infection.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Zero confirmed allergic reactions to cefazolin in an elective orthopedic cohort with high prevalence of reported beta-lactam allergies.JSES reviews, reports, and techniques · 2026Article
- Appropriateness of surgical antibiotic prophylaxis in Spanish hospitals: a national multicentre cross-sectional study.The Lancet regional health. Europe · 2026Article
- Comment on "prophylactic use of topical vancomycin reduces the incidence of postoperative wound infection in surgery for spinal metastases".European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Delabeling penicillin allergies in plastic and reconstructive surgery: Cefazolin as the cornerstone for antibiotic prophylaxis.JPRAS open · 2026Review
- Interpreting topical antibiotic prophylaxis in posterior spinal fusion: beyond overall infection rates.Spine deformity · 2026Article
- β-Lactam vs Non-β-Lactam Prophylaxis in Elective Colorectal Surgery.JAMA network open · 2026Observational
- Guideline Adherence of Perioperative Antibiotics and Surgical Site Infections in Noncardiac Surgery.JAMA network open · 2026Article
- Penicillin allergy de-labelling by non-allergy specialists in the elective surgical setting: A mixed-methods systematic review protocol.Anaesthesia reportsReview
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: β-lactam-based surgical antimicrobial prophylaxis (SAP) is the standard for most surgical procedures. Alternatively, and mostly due to allergies, non-β-lactam-based prophylaxis is used. The association between the use of non-β-lactam SAP and an increased risk of surgical site infection (SSI) rate has not yet been conclusively described. Objective: To assess whether non-β-lactam vs β-lactam prophylaxis is associated with the occurrence of SSI. Design, Setting, and Participants: This cohort study was based on the Swissnoso SSI surveillance system of 175 hospitals, including adult patients who underwent a major surgical procedure with SAP administration within 120 minutes prior to incision and postdischarge follow-up from January 2009 to December 2020. Patients with wound contamination class IV were excluded. Data analysis was conducted from July to December 2024. Exposures: β-Lactam SAP vs non-β-lactam SAP. Main Outcomes and Measures: The main outcome was occurrence of SSI, according to Centers for Disease Control and Prevention definitions. Mixed-effects logistic regression models were used to adjust for institutional, patient, and perioperative confounding factors. Results: Of 538 976 surveilled patients, 348 885 (196 411 [56.3%] female; median [IQR] age, 63.2 [47.0-73.3] years) fulfilled eligibility criteria. β-Lactam SAP was administered in 342 936 patients (98.3%) and non-β-lactam SAP in 5949 patients (1.7%). SSI was diagnosed in 9507 patients (2.8%) exposed to β-lactam SAP vs 364 patients (6.1%) who received non-β-lactam SAP (P < .001). Non-β-lactam SAP was significantly associated with a higher SSI rate (adjusted odds ratio [aOR], 1.78; 95% CI, 1.59-1.99; P < .001) compared with β-lactam SAP. A higher SSI rate for non-β-lactam SAP was found across all procedure types. Secondary analyses found a higher risk of SSI for ciprofloxacin (aOR, 1.57; 95% CI, 1.33-1.87; P < .001), vancomycin (aOR, 1.38; 95% CI, 1.03-1.86; P = .04), and clindamycin (aOR, 2.12; 95% CI, 1.82-2.47; P < .001) compared with β-lactam SAP. Conclusions and Relevance: In this large cohort study, administration of non-β-lactam SAP was associated with 1.8-fold higher odds of SSI. These findings suggest that non-β-lactam SAP should be avoided whenever possible. A careful evaluation of patients with reported β-lactam allergy should be performed before administering a second-choice antibiotic.
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