• Michael Carter, Rajkishen Narayanan, Gregory Toci, Rachel Huang, Jonathan Dalton, Alexa Tomlak, Yunsoo Lee, Shiraz Mumtaz, Matthew Sabitsky, Asad Pasha, Andrew Vanichkachorn, Andrew Kim, Amit Syal, Mark Kurd, Ian David Kaye, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Gregory Schroeder, and Christopher Kepler.
• Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
• Spine. 2024 Oct 30.

Study DesignRetrospective cohort study.ObjectiveTo compare peri- and postoperative infection rates among patients with mild to moderate penicillin allergies who receive cefazolin vs vancomycin as prophylaxis for lumbar fusion. Additionally, we sought to determine if patients receiving cefazolin exhibited any clinical symptoms suggestive of drug-induced hypersensitivity reactions, and to compare those rates to patients who received vancomycin.Summary Of Background DataCefazolin has been historically linked to hypersensitivity reactions in penicillin-allergic patients due to cross-reactivity. As a result, vancomycin is often given to these patients instead. To our knowledge, no studies have directly compared these two antibiotics in penicillin-allergic patients undergoing lumbar fusion.MethodsPatients with mild to moderate documented penicillin allergies who underwent lumbar fusion from 2017-2022 and received prophylactic cefazolin or vancomycin were studied. Demographic, surgical information, and hospital length of stay (LOS) were recorded. We identified drug sensitivity reactions, in hospital infections, 90-day readmissions related to infectious etiologies and need for irrigation and debridement (I&D) to treat a surgical site infection.Results222 patients received cefazolin, while 180 received vancomycin. Patients receiving vancomycin had more medical comorbidities, while patients receiving cefazolin had slightly more levels fused. No significant differences existed between cohorts in postoperative infection rate. One patient given cefazolin developed a mild drug-induced skin reaction that was treated with topical steroids. No significant differences existed between cohorts in 90-day readmissions or need for I&D surgery. On bivariate analysis, patients given cefazolin had a longer LOS but this was attributed to confounding variables on multivariate analysis.ConclusionsCefazolin and vancomycin are comparable at preventing postoperative infections among patients with mild to moderate documented reactions to penicillin. Our findings also suggest that penicillin-allergic patients are not at higher risk of developing drug-related hypersensitivity reactions in response to cefazolin exposure when compared to those who received vancomycin.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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