Postoperative infections after sinus lifts and onlay grafts in penicillin allergic patients

Mehdi Boussaïd; Mickael Samama; Jean Philippe Foy; Alexandre Bleibtreu; Chloé Bertolus; Timothée Gellee

doi:10.1016/j.jormas.2024.101764

Postoperative infections after sinus lifts and onlay grafts in penicillin allergic patients

J Stomatol Oral Maxillofac Surg. 2024 Jan 11;125(5):101764. doi: 10.1016/j.jormas.2024.101764. Online ahead of print.

Authors

Mehdi Boussaïd¹, Mickael Samama², Jean Philippe Foy², Alexandre Bleibtreu³, Chloé Bertolus², Timothée Gellee²

Affiliations

¹ Department of Maxillo-facial Surgery, Hôpital Pitié Salpêtrière, Medecine Sorbonne Université, 47-83 Boulevard de l'Hôpital, Paris, 75013, France. Electronic address: mehdibouss75013@gmail.com.
² Department of Maxillo-facial Surgery, Hôpital Pitié Salpêtrière, Medecine Sorbonne Université, 47-83 Boulevard de l'Hôpital, Paris, 75013, France.
³ Department of Infectiology, Hôpital Pitié Salpêtrière, Medecine Sorbonne Université, 47-83 Boulevard de l'Hôpital, Paris, 75013, France.

PMID: 38218333
DOI: 10.1016/j.jormas.2024.101764

Abstract

Introduction: The primary objective of this retrospective study was to determine whether patients treated with clindamycin due to a reported allergy to penicillin have an increased risk of postsurgical infections after sinus lifts and onlay grafts.

Material and methods: A retrospective cohort study was performed on patients who underwent bone reconstruction procedures between October 2018 and December 2020. Data from all patients operated at the Pitié Salpêtrière University Hospital for sinus lifts or onlay grafts were collected. All surgical procedures studied were performed under preoperative and postoperative antibiotic prophylaxis with either amoxicillin (+/- clavulanic acid) or clindamycin for patients with reported penicillin allergy. Bone graft-associated infections as well as graft failures were recorded.

Results: In this study, 111 patients received bone reconstructions (89 sinus lifts and 148 onlay grafts). In the sinus lifts group, infections occurred in 5 of 89 sites (5.6 %). The infection rate was 28.5 % (7 graft sites) and only 3.9 % (82 graft sites) for clindamycin and for amoxicillin, respectively. In the onlay graft group, infections occurred in 25 of 148 sites (16.8 %). The infection rate was 56 % and only 12 % for clindamycin (18 graft sites) and for amoxicillin, respectively (130 graft sites). Non-Penicillin treated patients had a higher risk of infection with an odd ratio of 7.8 (95 % CI 1.1-54.8, P = 0.04) and 4.8 (95 % CI 1.9-12.3, P = 0.001) compared with patients receiving amoxicillin for onlay grafts and sinus lifts.

Conclusion: Penicillin allergy and clindamycin use after sinus lift and onlay graft procedures were associated with a higher rate of infection and may be a risk factor for complications related to bone reconstruction surgery.

Keywords: Allergy; Bone grafting; Infections; Oral surgery; Penicillin; Postoperative period.