{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:53:10Z","timestamp":1792443190047,"version":"4.5.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"\n Background:<\/jats:title>\n Cefazolin, a first-generation cephalosporin, is the standard antibiotic for perioperative prophylaxis in patients undergoing hip or knee arthroplasty. Research has demonstrated significantly higher periprosthetic joint infection (PJI) rates when non-cefazolin antibiotics are used for prophylaxis. Notably, cefazolin contains an R1 side chain that has not shown cross-reactivity with other cephalosporins. However, in patients with a reported cephalosporin allergy, there is often uncertainty about the optimal antibiotic choice. This study aimed to determine the safety of perioperative cefazolin in patients with a documented cephalosporin allergy undergoing joint arthroplasty.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n We reviewed the records of 1,268 patients who had a documented cephalosporin allergy and underwent total hip or knee arthroplasty at a high-volume academic center from 2016 to 2024. We compared patients who received cefazolin despite a cephalosporin allergy (n = 482) and patients who received an alternative antibiotic prophylaxis (n = 786). The primary outcome was the incidence of immunoglobulin E (IgE)-mediated allergic reactions or \u201csevere\u201d Type-IV delayed hypersensitivity reactions with end organ dysfunction within 72 hours postoperatively. The secondary outcomes included 90-day rates of complications including PJI,\n Clostridioides difficile<\/jats:italic>\n infections, adverse events related to the antibiotic, and readmission.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The incidence of an allergic reaction in patients with an allergy to cephalosporin who received cefazolin was 0.0% (0 of 482) compared with 0.51% (4 of 786) in patients who received an alternative antibiotic prophylaxis (p = 0.30). There were no significant differences in the rates of PJI after primary arthroplasty (0.21% compared with 0.26%; p = 0.83),\n C. difficile<\/jats:italic>\n infection (0.0% compared with 0.0%), or readmission within 90 days (3.95% compared with 4.33%; p = 0.75). One patient who received cefazolin experienced mild, self-limited urethral irritation. Five patients receiving alternative antibiotics experienced antibiotic-related adverse events, including skin reactions, gastrointestinal distress, pancreatitis, and headache.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n In this cohort of patients undergoing joint arthroplasty, cefazolin administration in patients with a cephalosporin allergy was associated with a 0.0% incidence of IgE-mediated or severe Type-IV allergic reactions.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level III<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.25.01349","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T19:00:28Z","timestamp":1769540428000},"page":"e15","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Cefazolin and the R1 Side Chain"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4589-3933","authenticated-orcid":false,"given":"Josef E.","family":"Jolissaint","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"Mallett","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2884-8353","authenticated-orcid":false,"given":"Andrew L.","family":"Thomson","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3129-705X","authenticated-orcid":false,"given":"Alberto V.","family":"Carli","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4379-3392","authenticated-orcid":false,"given":"Matthew S.","family":"Austin","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"issue":"3","key":"bib1-20260730","doi-asserted-by":"crossref","DOI":"10.2146\/ajhp120568","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Am J Health Syst Pharm."},{"issue":"2S","key":"bib2-20260730","doi-asserted-by":"crossref","first-page":"S279","DOI":"10.1016\/j.arth.2018.09.012","article-title":"Hip and Knee Section, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections","volume":"34","author":"Aboltins","year":"2019","journal-title":"J Arthroplasty."},{"issue":"6_Supple_B","key":"bib4-20260730","doi-asserted-by":"crossref","DOI":"10.1302\/0301-620X.101B6.BJJ-2018-1407.R1","article-title":"2019 John Charnley Award: Increased risk of prosthetic joint infection following primary total knee and hip arthroplasty with the use of alternative antibiotics to cefazolin: the value of allergy testing for antibiotic prophylaxis","volume":"101-B","author":"Wyles","year":"2019","journal-title":"Bone Joint J."},{"issue":"3","key":"bib5-20260730","doi-asserted-by":"crossref","DOI":"10.1213\/ANE.0000000000003419","article-title":"Misconceptions surrounding penicillin allergy: implications for anesthesiologists","volume":"127","author":"Vorobeichik","year":"2018","journal-title":"Anesth Analg."},{"issue":"6","key":"bib6-20260730","article-title":"Chief Editor(s); Workgroup Contributors; Joint Task Force on Practice Parameters Reviewers. Drug allergy: a 2022 Practice Parameter Update","volume":"150","author":"Khan","year":"2022","journal-title":"J Allergy Clin Immunol."},{"issue":"3","key":"bib7-20260730","doi-asserted-by":"crossref","DOI":"10.1016\/j.surg.2021.03.022","article-title":"Safety of administering cefazolin versus other antibiotics in penicillin-allergic patients for surgical prophylaxis at a major Canadian teaching hospital","volume":"170","author":"Grant","year":"2021","journal-title":"Surgery."},{"issue":"5","key":"bib8-20260730","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaip.2018.01.020","article-title":"Cross-reactivity and tolerability of cephalosporins in patients with IgE-mediated hypersensitivity to penicillins","volume":"6","author":"Romano","year":"2018","journal-title":"J Allergy Clin Immunol Pract."},{"issue":"8","key":"bib9-20260730","doi-asserted-by":"crossref","first-page":"2722","DOI":"10.1016\/j.jaip.2019.05.038","article-title":"Cross-reactivity to cephalosporins and carbapenems in penicillin-allergic patients: two systematic reviews and meta-analyses","volume":"7","author":"Picard","year":"2019","journal-title":"J Allergy Clin Immunol Pract."},{"issue":"9S2","key":"bib10-20260730","article-title":"Perioperative cefazolin for total joint arthroplasty patients who have a penicillin allergy: is it safe?","volume":"39","author":"Bukowski","year":"2024","journal-title":"J Arthroplasty."},{"issue":"7","key":"bib11-20260730","doi-asserted-by":"crossref","DOI":"10.1007\/s11999-015-4672-4","article-title":"Is vancomycin-only prophylaxis for patients with penicillin allergy associated with increased risk of infection after arthroplasty?","volume":"474","author":"Tan","year":"2016","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"bib12-20260730","doi-asserted-by":"crossref","first-page":"ofad224","DOI":"10.1093\/ofid\/ofad224","article-title":"Cefazolin vs second-line antibiotics for surgical site infection prevention after total joint arthroplasty among patients with a beta-lactam allergy","volume":"10","author":"Norvell","year":"2023","journal-title":"Open Forum Infect Dis."},{"issue":"2","key":"bib13-20260730","doi-asserted-by":"crossref","DOI":"10.5435\/JAAOS-D-22-00122","article-title":"Documented penicillin allergies should not preclude use of preoperative cefazolin in hip and knee arthroplasty","volume":"31","author":"Kurcz","year":"2023","journal-title":"J Am Acad Orthop Surg."},{"key":"bib14-20260730","doi-asserted-by":"crossref","first-page":"101389","DOI":"10.1016\/j.gore.2024.101389","article-title":"Quality corner: safely using cephalosporins in almost all patients with penicillin allergies: mini-review and suggested protocol to improve efficacy and surgical outcomes","volume":"53","author":"Boitano","year":"2024","journal-title":"Gynecol Oncol Rep."},{"issue":"24","key":"bib15-20260730","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.21.00027","article-title":"A simple algorithmic approach allows the safe use of cephalosporin in \u201cpenicillin-allergic\u201d patients without the need for allergy testing","volume":"103","author":"Goh","year":"2021","journal-title":"J Bone Joint Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01349","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:43:40Z","timestamp":1787751820000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01349"}},"subtitle":["Why Patients with a Cephalosporin Allergy Can Be Safely Given Cefazolin While Undergoing Joint Arthroplasty"],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":14,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.01349","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]}}}