Outcomes of Cefazolin Administration in a Propensity Matched Cohort of Penicillin Allergic Patients Compared to Non-penicillin Allergic Patients

Study DesignRetrospective cohort study.ObjectiveTo investigate whether cefazolin can be given to penicillin-allergic patients undergoing spine surgery without significantly increasing rates of allergic reactions. Additionally, we sought to determine if patients receiving cefazolin would be at increased risk of surgical site infection due to allergy-associated skin or wound reactions.MethodsPatients with a documented penicillin allergy who underwent lumbar fusion from 2017-2022 and received cefazolin for surgical prophylaxis were matched to a cohort of non-penicillin allergic patients. Length of surgery and in-hospital complications related to infections were recorded for each patient. Allergic reactions were recorded, in addition to all-cause mortality, hospital length of stay (LOS), 30 and 90 day readmissions due to infectious etiologies and need for irrigation and debridement (I&D) surgery.Results254 penicillin-allergic patients were matched to 762 non-allergic patients. Penicillin- allergic patients had a comparable LOS when compared to non-allergic patients and had comparable incidences of respiratory complaints, sepsis, cellulitis, wound infections and all-cause mortality. While one penicillin-allergic patient was diagnosed with a mild drug-induced skin reaction, overall, cefazolin did not increase rates of allergic reactions compared to the non-allergic cohort. Cefazolin administration to penicillin allergic patients also did not significantly increase 90 day readmissions due to surgical site infections or need for subsequent I&D.ConclusionOur findings suggest that cefazolin can be safely administered to penicillin-allergic patients undergoing lumbar spine surgery without risk of cross-reactivity. Additionally, we found that cefazolin did not increase rates of non-surgical site infections or postoperative wound complications.