The Impact of Non-Beta-Lactam Antibiotic Use and Beta-Lactam Allergy Status on Surgical Site Infections: An Analysis of 49,279 Surgical Procedures

Introduction: Surgical site infections (SSIs) pose significant health and economic burdens. Beta-lactams are the recommended prophylactic antibiotics for most surgical procedures. However, the impact of non-beta-lactam antibiotics on SSI incidence is controversial. The objective of this study was to evaluate the efficacy of beta-lactam antibiotics in preventing SSIs across various surgical specialties and assess the impact of non-beta-lactam antibiotic use and reported beta-lactam allergy on SSI incidence.

Methods: A retrospective cohort study of a prospectively recorded database at a quaternary health center of patients who underwent surgery from January 2021 to February 2024 was performed. Exposures included antibiotic choice and reported beta-lactam allergy, with covariates including demographics, comorbidities, and procedure details. The main outcome was SSI incidence, analyzed using chi-squared tests and logistic regression (significance p < 0.05).

Results: The study included 49,279 procedures across ten specialties. Patients were aged 13-103 years (mean: 61.0±15.9). Procedures using non-beta-lactam antibiotics had a 69% higher SSI incidence (2.2% vs. 1.3%, p < 0.001). Patients with reported beta-lactam allergy had a 38% higher incidence of SSI (1.8% vs. 1.3%, p = 0.003). These associations were present in logistic regression as well. However, upon controlling for covariates and beta-lactam allergy, non-beta-lactam antibiotic use remained significantly associated with higher SSI incidence (OR 1.37, 95% CI 1.04 to 1.78, p = 0.020), while the association between beta-lactam allergy and SSI incidence became insignificant (OR 1.16, 95% CI 0.93 to 1.44, p = 0.169).

Conclusion : Beta-lactam antibiotic use effectively reduces SSI incidence, and reported beta-lactam allergy does not independently impact SSI. Use of a non-beta-lactam antibiotic is a critical SSI risk factor, emphasizing the need for accurate allergy reaction assessment and intentional antibiotic stewardship.