{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:22:54Z","timestamp":1791872574310,"version":"4.3.4"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"\n Importance<\/jats:title>\n Surgical site infections (SSIs) pose significant health and economic burdens. \u03b2-lactams are the recommended prophylactic antibiotics for most surgical procedures; however, the association of non\u2013\u03b2-lactam antibiotics with SSI incidence is controversial.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between reported \u03b2-lactam allergy status, \u03b2-lactam antibiotics, and SSIs across various surgical specialties.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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 \n Exposures<\/jats:title>\n Study exposures included antibiotic choice and reported \u03b2-lactam allergy, with covariates including demographics, comorbidities, and procedure details.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary study outcome was 30- to 90-day SSI incidence.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study included 49\u202f279 procedures across 10 specialties, with a total of 41\u202f100 patients (mean [SD] age, 61.0 [15.9] years; range, 13-103 years; 21\u202f237 male [51.7%]). Procedures with non\u2013\u03b2-lactam antibiotic use had a higher incidence of SSI than procedures with \u03b2-lactam antibiotic use (2.2% vs 1.3%; risk ratio [RR], 1.69; 95% CI, 1.28-2.01;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Procedures in patients with reported \u03b2-lactam allergy had a higher incidence of SSI (1.8% vs 1.3%; RR, 1.38; 95% CI, 1.15-1.64;\n P<\/jats:italic>\n \u2009=\u2009.003). These associations were present in logistic regression as well. However, on controlling for covariates and \u03b2-lactam allergy, non\u2013\u03b2-lactam antibiotic use remained significantly associated with higher SSI incidence (odds ratio [OR], 1.33; 95% CI, 1.00-1.74;\n P<\/jats:italic>\n \u2009=\u2009.04), whereas the association between \u03b2-lactam allergy and SSI incidence became nonsignificant (OR, 1.21; 95% CI, 0.97-1.49;\n P<\/jats:italic>\n \u2009=\u2009.09). In subspecialty analysis, only orthopedic surgery retained a significant association between non\u2013\u03b2-lactam use and increased SSI (OR, 3.01; 95% CI, 1.41-6.01;\n P<\/jats:italic>\n \u2009=\u2009.003).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cohort study found that \u03b2-lactam prophylaxis was associated with significantly lower SSI rates than non\u2013\u03b2-lactam agents, and a reported \u03b2-lactam allergy did not independently predict infection risk. Implementation of an allergy-focused stewardship guideline was associated with a marked reduction in non\u2013\u03b2-lactam use, underscoring the importance of precise allergy assessment to avoid unnecessary alternative prophylaxis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2025.3789","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T15:01:10Z","timestamp":1759330870000},"page":"1260","source":"Crossref","is-referenced-by-count":12,"title":["Non\u2013\u03b2-Lactam Antibiotic Use, \u03b2-Lactam Allergy, and Surgical Site Infections"],"prefix":"10.1001","volume":"160","author":[{"given":"Prateek","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit Prem","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise-Marie","family":"Oleksiuk","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Crall","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrej A.","family":"Petrov","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Pittsburgh Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin K.","family":"McCreary","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Holder-Murray","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue-Fang","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"},{"name":"Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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