ArticleNorth American Spine Society journal2026
Cefazolin prophylaxis is associated with lower surgical site infection risk than vancomycin following elective spine surgery.
Article in North American Spine Society journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- [Perioperative antibiotic prophylaxis in trauma surgery and orthopedics].Unfallchirurgie (Heidelberg, Germany) · 2026Article
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10 authors.
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Abstract
Background: Surgical site infection (SSI) remains a major cause of morbidity following elective spine surgery, with incidence rates up to 3%. Current guidelines recommend cefazolin as the first-line prophylactic antibiotic due to its efficacy against methicillin-sensitive Methods: A retrospective cohort analysis was conducted using the TriNetX US Collaborative Network (2015-2023). Adults undergoing elective spine surgery, including transforaminal or posterior interbody fusion (TLIF/PLIF), multilevel lumbar fusion, posterior cervical fusion, anterior cervical discectomy and fusions (ACDF), and microdiscectomy, were identified. Patients receiving perioperative cefazolin or vancomycin within 24 hours of surgery were included. 1:1 propensity score matching controlled for demographics, comorbidities, and infection risk factors. The primary outcome was 90-day SSI, assessed using ICD-10 diagnosis codes. Risk ratios (RR) were estimated using Cox proportional hazards models. Results: After matching, 12,996 patients were included across 5 procedure cohorts. Cefazolin prophylaxis was associated with lower or comparable SSI risk compared with vancomycin across all procedures. Statistically significant differences were observed for TLIF/PLIF (0.82% vs. 2.30%; RR 0.36, 95% CI 0.18-0.7; p = .0019) and microdiscectomy (0.34% vs. 0.69%; RR 0.50, 95% CI 0.27-0.93; p = .025). Nonsignificant trends favored cefazolin for posterior cervical fusion (0.88% vs. 1.41%), multilevel lumbar fusion (1.25% vs. 1.51%), and ACDF (0.30% vs. 0.54%). Conclusions: Cefazolin prophylaxis is associated with significantly lower SSI risk in elective spine procedures. These findings support cefazolin as the preferred perioperative antibiotic and emphasize the need for accurate B-lactam allergy assessment to optimize infection prevention and antimicrobial stewardship in spine surgery.
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