New findings on antibiotic prophylaxis in surgery
A study led by the University of Lucerne has found that some antibiotics are associated with almost double the risk of wound infections following surgery. These drugs are often prescribed when an allergy is suspected.
Cephalosporin antibiotics based on beta-lactam – a group that also includes penicillins – are the standard treatment for preventing wound infections in most surgical procedures. They are administered before surgery to combat bacteria that may contaminate the surgical site during the operation. The choice of antibiotic depends on factors such as the type of surgery, the local pathogen and resistance situation, and the patient’s individual risk factors. If an allergy to these antibiotics is suspected, non-beta-lactam antibiotics are frequently used instead.
Collaboration across institutions
Whether the use of non-beta-lactam antibiotics increases the risk of postoperative wound infections was the focus of a study published in late October 2025 in the medical journal JAMA Network Open. The research team included experts from the Universities of Bern and Basel, the University Hospitals of Geneva, Basel and Bern, and the Valais Hospital in Sion. The study was led by Professor Rami Sommerstein, MD, lecturer and research fellow at the University of Lucerne, and specialist in infectious diseases and hospital hygiene at the Hirslanden Clinic St. Anna.
Almost double the risk
The cohort study analysed data from 348,885 patients in 175 Swiss hospitals who underwent one of ten major surgical procedures. Of these, 5,949 patients – around two per cent – did not receive a beta-lactam antibiotic. The findings show that using non-beta-lactam antibiotics for surgical prophylaxis is associated with nearly twice the risk of postoperative wound infection. This elevated risk was consistent across all surgical fields and types of procedures. Moreover, it applied to all individual non-beta-lactam antibiotics studied, including ciprofloxacin, clindamycin and vancomycin.
This large-scale study was made possible thanks to Swissnoso, the National Centre for Infection Prevention, which has been conducting standardised monitoring of surgical wound infections in Swiss hospitals on behalf of the ANQ (National Association for Quality Development in Hospitals and Clinics) for many years. As part of this work, Swissnoso also surveys patients after their hospital stay.
Careful assessment recommended
The study’s findings are highly relevant for clinical practice. In the vast majority of cases, patients do not have a genuine allergy to cephalosporin beta-lactam antibiotics. Cross-allergies with penicillin-based beta-lactams are rare, and beta-lactam allergies can also subside spontaneously over time. Before resorting to alternative antibiotics, patients with a reported beta-lactam allergy should therefore be carefully assessed – and non-beta-lactam antibiotics should be avoided whenever possible.
Selina Largiadèr, Delphine Berthod, Andreas Widmer, Nicolas Troillet, Holly Jackson, Christelle Perdrieu, Stephan Harbarth, Rami Sommerstein
β-Lactam vs Non–β-Lactam Antimicrobial Prophylaxis and Surgical Site Infection
JAMA Network Open, 31 October 2025
