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Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin : A report from the Swedish Knee Arthroplasty Register on 78,000 primary total knee arthroplasties for osteoarthritis

Robertsson, Otto LU ; Thompson, Olof LU ; W-Dahl, Annette LU ; Sundberg, Martin LU ; Lidgren, Lars LU and Stefánsdóttir, Anna LU (2017) In Acta Orthopaedica 88(5). p.562-567
Abstract

Background and purpose — Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods — Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009–2015 were included in the study. Information on which antibiotic was used was available... (More)

Background and purpose — Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods — Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009–2015 were included in the study. Information on which antibiotic was used was available for 80,018 operations (55,530 patients). Survival statistics were used to calculate the rate of revision due to infection until the end of 2015, comparing the group of patients who received cloxacillin with those who received clindamycin as systemic prophylaxis. Results — Cloxacillin was used in 90% of the cases, clindamycin in 7%, and cephalosporins in 2%. The risk of being revised due to infection was higher when clindamycin was used than when cloxacillin was used (RR =1.5, 95% CI: 1.2–2.0; p = 0.001). There was no significant difference in the revision rate for other causes (p = 0.2). Interpretation — We advise that patients reporting allergic reaction to penicillin should have their allergic history explored. In the absence of a clear history of type-I allergic reaction (e.g. urticaria, anaphylaxis, or bronchospasm), we suggest the use of a third-generation cephalosporin instead of clindamycin as perioperative prophylaxis when undergoing a TKR. No recommendation can be given regarding patients with type-1 allergy.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Clindamycin., PROPHYLAXIS, cloxacillin, knee and hip arthroplasty
in
Acta Orthopaedica
volume
88
issue
5
pages
6 pages
publisher
Taylor & Francis
external identifiers
  • scopus:85027395351
  • pmid:28492106
  • wos:000407612900018
ISSN
1745-3674
DOI
10.1080/17453674.2017.1324677
language
English
LU publication?
yes
id
5f308239-6379-4914-a3bb-ec567d5a6b94
date added to LUP
2017-09-01 13:34:33
date last changed
2017-09-18 11:43:54
@article{5f308239-6379-4914-a3bb-ec567d5a6b94,
  abstract     = {<p>Background and purpose — Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods — Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009–2015 were included in the study. Information on which antibiotic was used was available for 80,018 operations (55,530 patients). Survival statistics were used to calculate the rate of revision due to infection until the end of 2015, comparing the group of patients who received cloxacillin with those who received clindamycin as systemic prophylaxis. Results — Cloxacillin was used in 90% of the cases, clindamycin in 7%, and cephalosporins in 2%. The risk of being revised due to infection was higher when clindamycin was used than when cloxacillin was used (RR =1.5, 95% CI: 1.2–2.0; p = 0.001). There was no significant difference in the revision rate for other causes (p = 0.2). Interpretation — We advise that patients reporting allergic reaction to penicillin should have their allergic history explored. In the absence of a clear history of type-I allergic reaction (e.g. urticaria, anaphylaxis, or bronchospasm), we suggest the use of a third-generation cephalosporin instead of clindamycin as perioperative prophylaxis when undergoing a TKR. No recommendation can be given regarding patients with type-1 allergy.</p>},
  author       = {Robertsson, Otto and Thompson, Olof and W-Dahl, Annette and Sundberg, Martin and Lidgren, Lars and Stefánsdóttir, Anna},
  issn         = {1745-3674},
  keyword      = {Clindamycin.,PROPHYLAXIS,cloxacillin,knee and hip arthroplasty},
  language     = {eng},
  month        = {09},
  number       = {5},
  pages        = {562--567},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin : A report from the Swedish Knee Arthroplasty Register on 78,000 primary total knee arthroplasties for osteoarthritis},
  url          = {http://dx.doi.org/10.1080/17453674.2017.1324677},
  volume       = {88},
  year         = {2017},
}