JAMA Netw Open

Non–β-lactam prophylaxis linked to nearly double the risk of surgical site infections

November 14, 2025

A Swiss cohort study of 348,885 patients across 175 hospitals found that non–β-lactam surgical antimicrobial prophylaxis (SAP) was associated with a nearly twofold increase in surgical site infections (6.1% vs. 2.8%) compared with β-lactams. Adjusted analyses showed non–β-lactam use carried 1.8 times higher odds of SSI, consistent across all procedure types. Ciprofloxacin, clindamycin, and vancomycin were associated with the greatest risk.

Clinical takeaway: Prioritize β-lactam prophylaxis whenever possible. Carefully evaluate patients with self-reported or poorly documented β-lactam allergy before administering second-line non–β-lactam SAP.

Source:

Largiader S, et al; Swissnoso Group. (2025, October 31). JAMA Netw Open. β-Lactam vs Non-β-Lactam Antimicrobial Prophylaxis and Surgical Site Infection. https://pubmed.ncbi.nlm.nih.gov/41171274/