Is Penicillin Allergy a Risk Factor for Surgical Site Infection After Oral and Maxillofacial Surgery?

Area of Science:

• Oral and Maxillofacial Surgery
• Infectious Disease
• Clinical Pharmacology

Background:

• Surgical site infection (SSI) prevention relies on perioperative antibiotics.
• Reported penicillin allergy complicates antibiotic selection for oral and maxillofacial surgery (OMS).
• The association between penicillin allergy and SSI risk in OMS is not fully understood.

Purpose of the Study:

• To investigate the association between reported penicillin allergy and the risk of developing SSI in OMS patients.
• To determine if antibiotic selection, rather than allergy itself, mediates this association.

Main Methods:

• Retrospective cohort study of 2,058 OMS patients (2011-2018).
• Analysis of dentoalveolar, orthognathic, pathology, and temporomandibular joint procedures.
• Logistic regression used to assess the impact of penicillin allergy and antibiotic choice on SSI rates.

Main Results:

• 15.5% of patients reported penicillin allergy.
• Penicillin-allergic patients received beta-lactams less frequently and clindamycin more frequently.
• Clindamycin use was associated with a higher SSI rate (5.6%) compared to beta-lactams (1.4%).
• Penicillin allergy showed a significant association with SSI (aOR 2.61).
• This association disappeared when controlling for antibiotic usage, indicating mediation by antibiotic selection.

Conclusions:

• Reported penicillin allergy increases SSI risk in OMS, primarily due to the use of non-beta-lactam antibiotics.
• Formal penicillin allergy evaluation is recommended for patients with suspected allergies.
• Optimizing perioperative antibiotic selection is crucial for SSI prevention in penicillin-allergic OMS patients.