Non–β-Lactam Antibiotic Use, β-Lactam Allergy, and Surgical Site Infections
Authors' conclusion
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.
Study context
- Population
- Patients who underwent surgery across 10 specialties at a quaternary health center, January 2021 to February 2024
- Participants
- 41,100 patients · 49,279 procedures
- Exposure
- Non-β-lactam vs β-lactam prophylactic antibiotics; reported β-lactam allergy vs none
- Outcome
- SSI incidence
- Follow-up
- 30 to 90 days
Methodological detailsprospectively recorded database, quaternary health center
- Prospectively recorded database
- Quaternary health center
Main finding
As reported in the abstract
Non-β-lactam vs β-lactamEstimate (95% CI)P value
SSI incidence
RR 1.69(1.28–2.01)
P < 0.001Adjusted for covariates and β-lactam allergy
OR 1.33(1.00–1.74)
P = 0.04Observational data: associations, not effects.
Further findings
| Outcome | β-lactam allergy | No reported allergy | Estimate | P value | |
|---|---|---|---|---|---|
| SSI incidence, reported β-lactam allergy | 1.8% | 1.3% | RR 1.38 (95% CI 1.15–1.64) | P = 0.003 | |
| SSI incidence, reported β-lactam allergyAdjusted; nonsignificant | OR 1.21 (95% CI 0.97–1.49) | P = 0.09 | |||
| SSI incidence, orthopedic surgery (subgroup)Non-β-lactam vs β-lactam · only specialty retaining significant association | OR 3.01 (95% CI 1.41–6.01) | P = 0.003 | |||
| 0.10.31310Ratio (log scale) |
Original publication
Non–β-Lactam Antibiotic Use, β-Lactam Allergy, and Surgical Site Infections. JAMA Surg. Published 1 November 2025. doi:10.
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