Preoperative antibiotic sensitivity testing for total joint replacement

Prosthetic joint infections are dreaded complications of total joint arthroplasty. Overreported antibiotic allergies have led to the avoidance of first-line antibiotics. This study assessed the efficacy of antibiotic sensitivity testing preoperatively in patients undergoing arthroplasty surgery. Patients who underwent antibiotic testing before shoulder, hip, or knee arthroplasty at our institution from December 2020 to November 2023 were retrospectively identified using current procedural terminology (CPT) coding. Primary outcomes were allergy test results and perioperative antibiotic received. Patients were divided into cohorts based on reported allergy, type of testing received, testing results, and perioperative antibiotic received. Descriptive analysis was performed. We identified 83 patients with a reported antibiotic allergy who received preoperative allergy testing before joint arthroplasty. Of these, 63 (75.9%) patients reported penicillin allergy, 4 (4.8%) reported cefazolin allergy, 1 (1.2%) reported vancomycin allergy, 12 (14.5%) reported an allergy to another cephalosporin, and 3 (3.6%) reported allergies to a combination of penicillin and cephalosporins. Of the 83 patients, 6 (7.2%) had a confirmed allergy according to allergy testing. A total of 78 (94.0%) patients received cefazolin. Of the 5 patients who received an alternative to cefazolin, all had a confirmed allergy during sensitivity testing. Preoperative antibiotic sensitivity testing highlights the disparity between reported and confirmed allergies. This study confirmed most patients with antibiotic allergies do not have true allergies and are able to receive cefazolin prophylaxis. Preoperative allergy testing is a valuable tool to ensure patients receive the standard of care, while still detecting patients with true allergies.