Cefazolin Is Superior to Cefonicid for Antibiotic Prophylaxis in Shoulder Surgery

Aims: Surgical site infection (SSI) is an uncommon but serious complication following shoulder surgery. Antibiotic prophylaxis is used routinely and has been shown to reduce the incidence of postoperative infections. Cefonicid, a second generation cephalosporin, was the prophylactic antibiotic used in our facility between May 2011 and July 2012. We had used Cefazolin, a first-generation cephalosporin, before and after this period. The switch to Cefonicid coincided with an apparent increased incidence of postoperative infections. This study aimed to determine whether the use of Cefonicid is correlated with higher rates of deep SSI following shoulder surgery.

Patients and Methods: This retrospective study included all patients who underwent shoulder surgery in our institution between July 2006 and June 2015. The medical records of all 2,670 patients were screened for SSI events and potential risk factors for the development of postoperative infection.

Results A total of 1,769 males and 901 females with a mean age of 47 (range 27 to 67) years were included. The mean follow-up time was 56 ± 30 months. Twenty-seven patients (1%) suffered a postoperative deep SSI, 20 of them with positive cultures. Patients pretreated with Cefonicid had a 4-fold higher risk of infection compared to those pretreated with Cefazolin (2.76% compared to 0.66%, respectively; p <0.001). Patients treated with Vancomycin or Clindamycin had a 6-fold higher risk of infection compared to those treated with Cefazolin (4% compared to 0.66%, respectively; p <0.001). Multivariate analysis revealed that older age (p < 0.05, OR=2.5) and pretreatment with Cefonicid (p < 0.001, OR=4( were independent risk factors for SSI.

Conclusion: We found a significantly lower rate of deep SSI following shoulder surgery with prophylactic Cefazolin compared to Cefonicid. We suggest that Cefonicid should not be used as a prophylactic agent in shoulder surgery.