A large cohort study found that “use of non-beta-lactam antibiotics before surgery should be avoided when possible.” CIDRAP has the news.
The study encompassed nearly 350,000 adults who were “administered surgical antibiotic prophylaxis (SAP) before undergoing a major surgical procedure.” There was a nearly twofold increase in surgical-site infection (SSI) rate with “those who received SAP with beta-lactam antibiotics.” Beta-lactam antibiotics are the “first-line choices for SAP for most surgical procedures to reduce the risk of SSIs.” Patients with “self-reported or documented beta-lactam allergies” require alternative options.
Of the 348,885 people included in the study, 98.3% “received beta-lactam SAP and [1.7%] received non-beta-lactam SAP. 9,871 people were diagnosed with having SSIs, and the “non–beta-lactam SAP group consistently had higher rates of superficial incisional infections (2.9% vs 1.0%), deep incisional infections (1.0% vs 0.4%), and organ-space infections (2.3% vs 1.3%).” Non-beta-lactam SAP was “significantly associated with a higher SSI rate (adjusted odds [aOR], 1.78) compared with beta-lactam SAP. The higher SSI rate was found across all surgical procedures.”
The study authors suggest that “since penicillin allergies are frequently unconfirmed, surgeons should test their patients before resorting to alternative antibiotics. While an estimated 10% to 15% of adults carry a beta-lactam allergy label, research has shown that up to 90% of those with the label may actually be beta-lactam tolerant.”
