{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:17:42Z","timestamp":1792451862046,"version":"4.5.0"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Previous studies found reduced surgical site infections (SSIs) with \u03b2-lactam surgical infection prophylaxis compared with non\u2013\u03b2-lactam alternatives; however, variations in timing and dosing have been reported. Whether guideline-concordant preoperative antibiotic dosing or timing are associated with reported SSI differences between regimens is unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the incidence of SSIs between patients receiving \u03b2-lactam and non\u2013\u03b2-lactam alternative prophylaxis, while controlling guideline-concordant dosing and timing.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multicenter retrospective cohort study used data from a validated regional data registry. Adult patients (&amp;gt;18 years) receiving \u03b2-lactam and non\u2013\u03b2-lactam alternative prophylaxis for elective colorectal surgery between July 2012 and June 2021 were included. Analyses were performed at multiple intervals between March 2022 and January 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Surgical prophylaxis regimens with \u03b2-lactam or non\u2013\u03b2-lactam alternative prophylaxis. Receipt of guideline-concordant prophylaxis dose and timing were variables of interest, defined using international guideline recommendations.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was 30-day SSI. Modified Poisson regression with robust (sandwich) variance estimators was used to estimate adjusted risk ratios (ARRs) for SSI comparing \u03b2-lactam with non\u2013\u03b2-lactam alternative prophylaxis, adjusting for guideline-concordant dosing, timing, and other covariates; 1:1 propensity score matching was performed as a sensitivity analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 20\u202f140 procedures (female, 10\u202f423 [51.8%]; male, 9717 [48.2%]; mean [SD] age, 62.0 [13.8] years), 18\u202f098 (89.9%) received \u03b2-lactam prophylaxis and 2042 (10.1%) received non\u2013\u03b2-lactam alternative prophylaxis. Baseline characteristics differed between groups. Patients in the \u03b2-lactam cohort more commonly received guideline-concordant antibiotic dosing (15\u202f124 [83.6%] vs 1084 [53.1%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), guideline-concordant timing (16\u202f946 [93.6%] vs 1707 [83.6%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), or combined guideline-concordant dose and timing (14\u202f216 [78.6%] vs 751 [36.8%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and had fewer SSIs (1114 [6.2%] vs 172 [8.4%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). After adjusting for confounders, \u03b2-lactam prophylaxis was associated with a lower risk of SSIs (ARR, 0.74; 95% CI, 0.63-0.87;\n P<\/jats:italic>\n &amp;lt; .001). Neither guideline-concordant dosing (ARR, 1.04; 95% CI, 0.91-1.20;\n P<\/jats:italic>\n = .54) nor timing (ARR, 1.13; 95% CI, 0.92-1.38;\n P<\/jats:italic>\n = .25) were associated with SSI risk.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of elective colorectal surgery procedures, \u03b2-lactam surgical prophylaxis was associated with significantly lower SSI risk compared with non\u2013\u03b2-lactam alternatives. Differences in guideline-concordant dosing and timing between cohorts were not associated with SSI risk in adjusted analyses.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.6708","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:30:36Z","timestamp":1776094236000},"page":"e266708","source":"Crossref","is-referenced-by-count":1,"title":["\u03b2-Lactam vs Non\u2013\u03b2-Lactam Prophylaxis in Elective Colorectal Surgery"],"prefix":"10.1001","volume":"9","author":[{"given":"Curtis D.","family":"Collins","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services, Trinity Health Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Hartsfield","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Trinity Health Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert 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