Lumbar Fusion Surgical Prophylaxis Using Cefazolin Versus Vancomycin in the Penicillin-Allergic Patient.

Authors

• Michael Carter
• Rajkishen Narayanan
• Gregory Toci
• Rachel Huang
• Jonathan Dalton
• Alexa Tomlak
• Yunsoo Lee
• Shiraz Mumtaz
• Matthew Sabitsky
• Asad Pasha
• Andrew Vanichkachorn
• Andrew Kim
• Amit Syal
• Mark Kurd
• Ian D Kaye
• Jose Canseco
• Alan Hilibrand
• Alexander Vaccaro
• Gregory Schroeder
• Christopher Kepler

Publication/Presentation Date

9-15-2025

Abstract

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To compare perioperative and postoperative infection rates among patients with mild to moderate penicillin allergies who receive cefazolin versus vancomycin as prophylaxis for lumbar fusion. In addition, we sought to determine if patients receiving cefazolin exhibited any clinical symptoms suggestive of drug-induced hypersensitivity reactions, and to compare those rates to patients who received vancomycin.

SUMMARY OF BACKGROUND DATA: Cefazolin has been historically linked to hypersensitivity reactions in penicillin-allergic patients due to cross-reactivity. As a result, vancomycin is often given to these patients instead. To our knowledge, no studies have directly compared these two antibiotics in penicillin-allergic patients undergoing lumbar fusion.

MATERIALS AND METHODS: Patients with mild to moderate documented penicillin allergies who underwent lumbar fusion from 2017 to 2022 and received prophylactic cefazolin or vancomycin were studied. Demographic, surgical information, and hospital length of stay (LOS) were recorded. We identified drug sensitivity reactions, in hospital infections, 90-day readmissions related to infectious etiologies and need for irrigation and debridement (I&D) to treat a surgical site infection.

RESULTS: Two hundred twenty-two patients received cefazolin, while 180 received vancomycin. Patients receiving vancomycin had more medical comorbidities, while patients receiving cefazolin had slightly more levels fused. No significant differences existed between cohorts in postoperative infection rate. One patient given cefazolin developed a mild drug-induced skin reaction that was treated with topical steroids. No significant differences existed between cohorts in 90-day readmissions or need for I&D surgery. On bivariate analysis, patients given cefazolin had a longer LOS but this was attributed to confounding variables on multivariate analysis.

CONCLUSIONS: Cefazolin and vancomycin are comparable at preventing postoperative infections among patients with mild to moderate documented reactions to penicillin. Our findings also suggest that penicillin-allergic patients are not at higher risk of developing drug-related hypersensitivity reactions in response to cefazolin exposure when compared with those who received vancomycin.

Volume

50

Issue

18

First Page

1267

Last Page

1272

ISSN

1528-1159

Published In/Presented At

Carter, M., Narayanan, R., Toci, G., Huang, R., Dalton, J., Tomlak, A., Lee, Y., Mumtaz, S., Sabitsky, M., Pasha, A., Vanichkachorn, A., Kim, A., Syal, A., Kurd, M., Kaye, I. D., Canseco, J., Hilibrand, A., Vaccaro, A., Schroeder, G., & Kepler, C. (2025). Lumbar Fusion Surgical Prophylaxis Using Cefazolin Versus Vancomycin in the Penicillin-Allergic Patient. Spine, 50(18), 1267–1272. https://doi.org/10.1097/BRS.0000000000005200

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

39477808

Department(s)

Administration and Leadership

Document Type

Article