Safety of Cefazolin Perioperative Prophylaxis in Plastic Surgery Patients With Penicillin Allergy: A Retrospective Chart Review

Introduction: Antimicrobial prophylaxis is crucial in reducing surgical site infections (SSIs). First-generation cephalosporins are commonly first line, but issues arise when patients report a penicillin allergy. Although up to 10% of Americans report a penicillin allergy, up to 95% are not truly allergic. Even patients with true penicillin allergy likely tolerate cephalosporins due to low cross-reactivity. Nevertheless, providers are less likely to prescribe cefazolin for these patients, increasing the risk of SSI. We seek to characterize the pattern of perioperative antibiotic use and rate of reaction in plastic surgery patients who endorse a penicillin allergy. Method: This was a single-center retrospective chart review of adults who received body contouring plastic surgery from January 1, 2021 to December 31, 2021. The presence of reported penicillin allergy and administration of cefazolin versus alternative agent were evaluated, and the outcome was measured in number of anaphylactic reactions and SSI events. Results: The study included 457 patients in total; 437 (96%) were female; 106 (23%) had listed allergy to penicillin, cephalosporin, or both - 17 (16%) were listed as having anaphylaxis to penicillin, 62 (58.5%) endorsed a nonanaphylactic allergic reaction to penicillin, 8 (7.5%) endorsed an allergy without a documented reaction to penicillin, and 19 (18%) reported a prior cephalosporin allergy. All patients with a beta-lactam allergy who received cefazolin perioperatively did not have any anaphylaxis events. Three patients who received clindamycin and 1 patient who received cefazolin developed SSI postoperatively. Conclusion: Cephalosporins should be the first line for appropriate patients with a penicillin allergy, as alternative agents have increased SSI risk.