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Consequences of reported β-lactam allergy on perioperative outcomes: a systematic review and meta-analysis of surgical site infection risk

Published online by Cambridge University Press:  10 September 2025

Yuki Hanai Open the ORCID record for Yuki Hanai [Opens in a new window] ,
Jun Hirai Open the ORCID record for Jun Hirai [Opens in a new window] ,
Kazuhiro Matsuo ,
Keita Kouzu Open the ORCID record for Keita Kouzu [Opens in a new window] ,
Hiroji Shinkawa ,
Seiichi Shinji Open the ORCID record for Seiichi Shinji [Opens in a new window] ,
Motomu Kobayashi ,
Yuichi Kitagawa ,
Chizuru Yamashita  and
Yasuhiko Mohri Open the ORCID record for Yasuhiko Mohri [Opens in a new window]
...Show all authors
Yuki Hanai*
Affiliation:
Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan
Jun Hirai
Affiliation:
Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan
Kazuhiro Matsuo
Affiliation:
Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan
Keita Kouzu
Affiliation:
Department of Surgery, National Defense Medical College, Saitama, Japan
Hiroji Shinkawa
Affiliation:
Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
Seiichi Shinji
Affiliation:
Department of Gastroenterological Surgery, Nippon Medical School, Tokyo, Japan
Motomu Kobayashi
Affiliation:
Department of Anesthesiology, Hokushinkai Megumino Hospital, Hokkaido, Japan
Yuichi Kitagawa
Affiliation:
Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan
Chizuru Yamashita
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
Yasuhiko Mohri
Affiliation:
Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan
Hiroshi Nobuhara
Affiliation:
Merry Hospital, Medical Corporation Yachiyokai, Hiroshima, Japan
Katsunori Suzuki
Affiliation:
Department of Infectious Disease Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
Junzo Shimizu
Affiliation:
Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
Motoi Uchino
Affiliation:
Department of Gastroenterological Surgery, Division of Inflammatory Bowel Disease, Hyogo Medical University, Hyogo, Japan
Seiji Haji
Affiliation:
Department of Surgery, Soseikai General Hospital, Kyoto, Japan
Masahiro Yoshida
Affiliation:
Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
Toru Mizuguchi
Affiliation:
Department of Nursing, Division of Surgical Science, Sapporo Medical University, Hokkaido, Japan
Toshihiko Mayumi
Affiliation:
Department of Intensive Care Unit, Japan Community Healthcare Organization Chukyo Hospital, Aichi, Japan
Yuko Kitagawa
Affiliation:
Department of Surgery, Keio University School of Medicine, Tokyo, Japan
Hiroki Ohge
Affiliation:
Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
*
Corresponding author: Yuki Hanai; Email: yuki.hanai@phar.toho-u.ac.jp
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Abstract

Objective:

To evaluate the impact of reported β-lactam allergy on the risk of surgical site infections (SSIs), given that most reported cases are unverified and may lead to suboptimal antibiotic prophylaxis.

Design:

Systematic review and meta-analysis.

Methods:

Four databases were systematically searched for studies reporting SSI rates in patients with and without β-lactam allergy. The primary outcome was SSI incidence; secondary outcomes included mortality, length of hospital stay (LOS) and adverse events. Subgroup analyses were conducted to explore potential sources of heterogeneity. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed using the ROBINS-I tool.

Results:

Twenty-five retrospective observational studies comprising 460,284 patients were included. Reported β-lactam allergy was associated with a significantly increased risk of SSI (RR = 1.55, 95% CI = 1.24–1.94). This association remained consistent across sensitivity and subgroup analyses, particularly in studies relying on self-reported allergies. Patients receiving β-lactam antibiotics had a significantly lower SSI risk than that of patients receiving non-β-lactam alternatives (RR = 0.63, 95% CI = 0.42–0.94). No significant differences were found in LOS or hypersensitivity reaction rates. Mortality was not reported in any of the included studies.

Conclusions:

Reported β-lactam allergy is associated with an increased risk of SSI, highlighting the importance of accurate allergy assessment. Selective administration of β-lactam agents, such as cefazolin, may offer a safe and effective option for preoperative prophylaxis in patients without a history of severe hypersensitivity.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 11 , November 2025 , pp. 1140 - 1150
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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