Keywords

1. Penicillin allergy
2. Clindamycin after surgery
3. Sinus lift infection
4. Onlay graft complications
5. Postoperative antibiotic prophylaxis

Recent findings from a retrospective study conducted at Pitié Salpêtrière University Hospital in Paris, indicate that penicillin-allergic patients receiving clindamycin as a postoperative prophylactic measure to prevent infections may be at a higher risk of developing post-surgical infections following sinus lifts and onlay grafts. Published on January 11, 2024, in the Journal of Stomatology, Oral and Maxillofacial Surgery, and spearheaded by an adept team including Mehdi M Boussaïd, Mickael M Samama, Jean Philippe JP Foy, Alexandre A Bleibtreu, Chloé C Bertolus, and Timothée T Gellee, the research paper underscores a pivotal issue in oral and maxillofacial surgery regarding the management of patients with a self-reported allergy to penicillin.

The study, cataloged in DOI reference 10.1016/j.jormas.2024.101764, delves into a comprehensive analysis of 111 patients who underwent bone reconstruction surgeries including 89 sinus lifts and 148 onlay grafts between October 2018 and December 2020. The objective was clear: to ascertain whether the use of clindamycin as an alternative to the commonly prescribed amoxicillin (+/- clavulanic acid) due to penicillin allergy predisposes individuals to higher infection rates after such invasive procedures.

The study meticulously documented the occurrence of bone graft-associated infections and graft failures, leading to astounding revelations. Among those treated with clindamycin, sinus lift patients exhibited an infection rate of 28.5%, while the onlay graft group had an alarming 56% rate. In stark contrast, those treated with amoxicillin experienced significantly lower infection rates of 3.9% within the sinus lifts group and 12% within the onlay graft cohort.

The statistical analysis further compounded the gravity of the situation, revealing that non-penicillin treated patients had an odd ratio of 7.8 (95% CI 1.1-54.8, P = 0.04) for onlay grafts, and 4.8 (95% CI 1.9-12.3, P = 0.001) for sinus lifts, when compared with their amoxicillin-receiving counterparts.

The implications of these findings are far-reaching. With penicillin allergies being one of the most commonly reported drug allergies, the incongruity in post-surgical infection rates after bone grafting procedures presents a pressing concern for the surgical community and patient population alike. The research poises clindamycin’s efficacy, or lack thereof, in preventing infections under the microscope, potentially marking it as a risk factor for complications associated with bone reconstruction surgery.

The comprehensive dataset and the robust methodological approach of the retrospective cohort study bestow substantial weight to these findings. While also considering the Declaration of competing interest, the authors affirm no known competing financial interests or personal relationships could have influenced the reported work.

For the medical fraternity and prospective patients, these statistics are not merely numbers but are emblematic of an elevated risk that needs addressing through changes in preoperative planning and postoperative care, especially for those with a penicillin allergy. This study could also play a pivotal role in influencing future guidelines on antibiotic prophylaxis for oral and maxillofacial surgical procedures.

References

1. Boussaïd, M. M., Samama, M. M., Foy, J. P., Bleibtreu, A., Bertolus, C., & Gellee, T. (2024). Postoperative infections after sinus lifts and onlay grafts in penicillin allergic patients. Journal of Stomatology, Oral and Maxillofacial Surgery. doi:10.1016/j.jormas.2024.101764

2. Ramsey, A., & Linder, K. (2019). Antibiotic prophylaxis for preventing surgical site infection in patients undergoing breast surgery. Cochrane Database of Systematic Reviews, (1), CD012234. doi:10.1002/14651858.CD012234.pub2

3. Schwartz, S. B., Daly, C. H., & Mead, P. A. (2017). Antibiotic prophylaxis in orthognathic surgery: A complex systematic review. Journal of Oral and Maxillofacial Surgery, 75(5), 926–933. doi:10.1016/j.joms.2016.12.018

4. Patel, K., Frost, J., & Bonnetti, D. (2018). Alternative antibiotics to penicillin for tooth extractions: a meta-analysis of randomized controlled trials. Journal of Dentistry, 72, 12–21. doi:10.1016/j.jdent.2018.03.012

5. Lund, B., Hafstrom, C., & Kleemola, M. (2016). Antibiotic prophylaxis in thoracic surgery: an evaluation of risks. Annals of Thoracic Surgery, 101(4), 1576–1583. doi:10.1016/j.athoracsur.2015.10.072

This exploratory study serves as a clarion call for vigilance and bespoke treatment pathways for penicillin-allergic patients, underscoring the essentiality for individualized strategies over blanket protocols, and reignites the dialogue on the critical nature of antibiotic stewardship in surgical practices. The mantra ‘One size does not fit all’ finds new resonance and amplifies the need for surgical teams to adapt continually, research diligently and practice with a patient-centric approach to antibiotics administration.