{"doi":"10.1001/jamasurg.2025.3789","title":"Non–β-Lactam Antibiotic Use, β-Lactam Allergy, and Surgical Site Infections","abstract":"<jats:sec id=\"ab-soi250063-4\">\n                    <jats:title>Importance</jats:title>\n                    <jats:p>Surgical site infections (SSIs) pose significant health and economic burdens. β-lactams are the recommended prophylactic antibiotics for most surgical procedures; however, the association of non–β-lactam antibiotics with SSI incidence is controversial.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-5\">\n                    <jats:title>Objective</jats:title>\n                    <jats:p>To evaluate the association between reported β-lactam allergy status, β-lactam antibiotics, and SSIs across various surgical specialties.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-6\">\n                    <jats:title>Design, Setting, and Participants</jats:title>\n                    <jats:p>This was a retrospective cohort study of a prospectively recorded database. The setting was a quaternary health center. Included in the study were patients who underwent surgery from January 2021 to February 2024.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-7\">\n                    <jats:title>Exposures</jats:title>\n                    <jats:p>Study exposures included antibiotic choice and reported β-lactam allergy, with covariates including demographics, comorbidities, and procedure details.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-8\">\n                    <jats:title>Main Outcomes and Measures</jats:title>\n                    <jats:p>The primary study outcome was 30- to 90-day SSI incidence.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-9\">\n                    <jats:title>Results</jats:title>\n                    <jats:p>\n                      The study included 49 279 procedures across 10 specialties, with a total of 41 100 patients (mean [SD] age, 61.0 [15.9] years; range, 13-103 years; 21 237 male [51.7%]). Procedures with non–β-lactam antibiotic use had a higher incidence of SSI than procedures with β-lactam antibiotic use (2.2% vs 1.3%; risk ratio [RR], 1.69; 95% CI, 1.28-2.01;\n                      <jats:italic>P</jats:italic>\n                       &amp;amp;lt; .001). Procedures in patients with reported β-lactam allergy had a higher incidence of SSI (1.8% vs 1.3%; RR, 1.38; 95% CI, 1.15-1.64;\n                      <jats:italic>P</jats:italic>\n                       = .003). These associations were present in logistic regression as well. However, on controlling for covariates and β-lactam allergy, non–β-lactam antibiotic use remained significantly associated with higher SSI incidence (odds ratio [OR], 1.33; 95% CI, 1.00-1.74;\n                      <jats:italic>P</jats:italic>\n                       = .04), whereas the association between β-lactam allergy and SSI incidence became nonsignificant (OR, 1.21; 95% CI, 0.97-1.49;\n                      <jats:italic>P</jats:italic>\n                       = .09). In subspecialty analysis, only orthopedic surgery retained a significant association between non–β-lactam use and increased SSI (OR, 3.01; 95% CI, 1.41-6.01;\n                      <jats:italic>P</jats:italic>\n                       = .003).\n                    </jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-10\">\n                    <jats:title>Conclusions and Relevance</jats:title>\n                    <jats:p>This cohort study found that β-lactam prophylaxis was associated with significantly lower SSI rates than non–β-lactam agents, and a reported β-lactam allergy did not independently predict infection risk. Implementation of an allergy-focused stewardship guideline was associated with a marked reduction in non–β-lactam use, underscoring the importance of precise allergy assessment to avoid unnecessary alternative prophylaxis.</jats:p>\n                  </jats:sec>","journal":"JAMA Surgery","year":2025,"id":622440,"datarank":0.3453877639491069,"base_score":2.302585092994046,"endowment":2.302585092994046,"self_citation_contribution":0.3453877639491069,"citation_network_contribution":0.0,"self_endowment_contribution":0.3453877639491069,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1305682,"name":"Rohit Prem Kumar","orcid":"0009-0003-4657-2864","position":1,"is_corresponding":false},{"id":1608300,"name":"Louise-Marie Oleksiuk","orcid":null,"position":2,"is_corresponding":false},{"id":1608301,"name":"Victoria Crall","orcid":null,"position":3,"is_corresponding":false},{"id":949989,"name":"Andrej A. Petrov","orcid":"0000-0002-2574-4626","position":4,"is_corresponding":false},{"id":362471,"name":"Erin K. McCreary","orcid":"0000-0001-6705-2225","position":5,"is_corresponding":false},{"id":761579,"name":"Jennifer Holder-Murray","orcid":null,"position":6,"is_corresponding":false},{"id":129015,"name":"Yue-Fang Chang","orcid":null,"position":7,"is_corresponding":false},{"id":399955,"name":"Nitin Agarwal","orcid":"0000-0003-0256-3897","position":8,"is_corresponding":false},{"id":1358389,"name":"D. Kojo Hamilton","orcid":"0009-0000-1534-340X","position":9,"is_corresponding":false},{"id":399960,"name":"Robert M. Friedlander","orcid":"0000-0003-4423-9219","position":10,"is_corresponding":false},{"id":1608298,"name":"Prateek Agarwal","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Non–β-Lactam Antibiotic Use, β-Lactam Allergy, and Surgical Site Infections","abstract":"<jats:sec id=\"ab-soi250063-4\">\n                    <jats:title>Importance</jats:title>\n                    <jats:p>Surgical site infections (SSIs) pose significant health and economic burdens. β-lactams are the recommended prophylactic antibiotics for most surgical procedures; however, the association of non–β-lactam antibiotics with SSI incidence is controversial.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-5\">\n                    <jats:title>Objective</jats:title>\n                    <jats:p>To evaluate the association between reported β-lactam allergy status, β-lactam antibiotics, and SSIs across various surgical specialties.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-6\">\n                    <jats:title>Design, Setting, and Participants</jats:title>\n                    <jats:p>This was a retrospective cohort study of a prospectively recorded database. The setting was a quaternary health center. Included in the study were patients who underwent surgery from January 2021 to February 2024.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-7\">\n                    <jats:title>Exposures</jats:title>\n                    <jats:p>Study exposures included antibiotic choice and reported β-lactam allergy, with covariates including demographics, comorbidities, and procedure details.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-8\">\n                    <jats:title>Main Outcomes and Measures</jats:title>\n                    <jats:p>The primary study outcome was 30- to 90-day SSI incidence.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-9\">\n                    <jats:title>Results</jats:title>\n                    <jats:p>\n                      The study included 49 279 procedures across 10 specialties, with a total of 41 100 patients (mean [SD] age, 61.0 [15.9] years; range, 13-103 years; 21 237 male [51.7%]). Procedures with non–β-lactam antibiotic use had a higher incidence of SSI than procedures with β-lactam antibiotic use (2.2% vs 1.3%; risk ratio [RR], 1.69; 95% CI, 1.28-2.01;\n                      <jats:italic>P</jats:italic>\n                       &amp;amp;lt; .001). Procedures in patients with reported β-lactam allergy had a higher incidence of SSI (1.8% vs 1.3%; RR, 1.38; 95% CI, 1.15-1.64;\n                      <jats:italic>P</jats:italic>\n                       = .003). These associations were present in logistic regression as well. However, on controlling for covariates and β-lactam allergy, non–β-lactam antibiotic use remained significantly associated with higher SSI incidence (odds ratio [OR], 1.33; 95% CI, 1.00-1.74;\n                      <jats:italic>P</jats:italic>\n                       = .04), whereas the association between β-lactam allergy and SSI incidence became nonsignificant (OR, 1.21; 95% CI, 0.97-1.49;\n                      <jats:italic>P</jats:italic>\n                       = .09). In subspecialty analysis, only orthopedic surgery retained a significant association between non–β-lactam use and increased SSI (OR, 3.01; 95% CI, 1.41-6.01;\n                      <jats:italic>P</jats:italic>\n                       = .003).\n                    </jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"ab-soi250063-10\">\n                    <jats:title>Conclusions and Relevance</jats:title>\n                    <jats:p>This cohort study found that β-lactam prophylaxis was associated with significantly lower SSI rates than non–β-lactam agents, and a reported β-lactam allergy did not independently predict infection risk. Implementation of an allergy-focused stewardship guideline was associated with a marked reduction in non–β-lactam use, underscoring the importance of precise allergy assessment to avoid unnecessary alternative prophylaxis.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"41032329","pmcid":null,"openalex_id":null,"authors":[],"funders":[],"total_grants":0,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[],"oa_status":"green","license":null,"oa_locations":[{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12489799/","host_type":"repository"},{"url":"https://jamanetwork.com/journals/jamasurgery/articlepdf/2839389/jamasurgery_agarwal_2025_oi_250063_1762891090.53649.pdf","host_type":"publisher"}],"fields_of_study":[],"mesh_terms":["Humans","Surgical Wound Infection","Drug Hypersensitivity","beta-Lactams","Anti-Bacterial Agents","Antibiotic Prophylaxis","Incidence","Retrospective Studies","Adolescent","Adult","Aged","Aged, 80 and over","Middle Aged","Female","Male","Young Adult"],"keywords":[],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-03T19:38:52.701973Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}